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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

May 2019

Highlights
HPHConnect: New Resource Page & Referral Update

We’ve upgraded HPHConnect to make it even more robust and easy to use, including introducing a new Resource Page and referral submission/status functionality for May 1 and new electronic authorization functionality in July.

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Updates to Electronic Authorization & Use of InterQual®

In addition to the HPHConnect enhancements we’ve announced (new home and resource pages, as well as referral page updates), Harvard Pilgrim is updating our electronic authorization screens and expanding our use of InterQual® criteria and tools beginning on July 15, 2019.

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Harvard Pilgrim Awards Nearly $620,000 in Healthy Food Fund Grants

Harvard Pilgrim is happy to announce that we recently awarded nearly $620,000 in new Healthy Food Fund grants to 25 not-for-profit community food access initiatives that grow or distribute fresh produce to low-income families and older adults in Connecticut, Maine, Massachusetts, and New Hampshire.

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Clinical Documentation Required for Radiology Services

To ensure that members receive the most appropriate and effective radiology procedure, for dates of service beginning July 1, 2019, Harvard Pilgrim will require requesting providers to submit clinical documentation for additional outpatient advanced imaging services for our commercial members.

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Cardiac Prior Authorization Program for Non-Emergent Tests & Procedures

For dates of services beginning July 1, 2019, Harvard Pilgrim will require prior authorization for commercial members for the following non-emergent cardiac diagnostic tests and interventional procedures through National Imaging Associates, Inc. (NIA).

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Reminder: NICU Program Begins June 1

Beginning June 1, 2019, ProgenyHealth’s neonatologists, pediatricians, and neonatal nurse case managers will work closely with neonatal intensive care unit (NICU) physicians, nurses, and facilities to perform utilization management, review of level of care, and discharge planning for babies receiving NICU care.

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HPHCURRENT EVENTS

HPHConnect: New Resource Page & Referral Update

Updates to Electronic Authorization & Use of InterQual®

Harvard Pilgrim Awards Nearly $620,000 in Healthy Food Fund Grants

Harvard Pilgrim’s Commitment to LGBTQ Equality and Inclusion

CLINICIAN CORNER

Clinical Documentation Required for Radiology Services

Cardiac Prior Authorization Program for Non-Emergent Tests & Procedures

Reminder: NICU Program Begins June 1

Reminder on Medical Drugs Obtained through Specialty Pharmacy

Updates to Commercial Hemlibra Prior Authorization Policy

Khapzory Now Covered with Prior Authorization for Commercial Plans

Identifying and Treating Postpartum Depression

Reminder: Naloxone and Narcan Nasal Spray Coverage

Cost-Effective Treatments for Seasonal Allergies

OFFICE ASSISTANT

Reimbursement for Modifiers SA & AS

Payment Policy Updates: Anesthesia and Pain Management

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator