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

May 2018

Highlights
Sign Up for a Webinar on Our Genetic Testing Program

Harvard Pilgrim and AIM Specialty Health® (AIM) are offering additional webinar sessions for providers, including genetic counselors, and office staff who wish to learn more about our genetic testing prior authorization program.

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Decreasing Preventable ED Visits and Hospital Readmissions

At the most recent Massachusetts Medical Directors’ Meeting, Harvard Pilgrim medical directors, the medical leaders of participating hospitals and provider organizations, and other local industry leaders discussed the importance of decreasing avoidable emergency department visits and hospital readmissions.

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Coverage of Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

Harvard Pilgrim has created a new medical policy for the management of scanning computerized ophthalmic diagnostic imaging (SCODI) — which includes confocal laser scanning ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography — effective for commercial members for dates of service beginning July 1, 2018.

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Update to Reimbursement of Codes With PC/TC Indicator of 3

Beginning July 1, 2018 for our commercial members, Harvard Pilgrim will no longer reimburse a physician or other health care professional for a procedure code that CMS has assigned a PC/TC indicator of 3 when it is billed with a facility place of service code, because those procedure codes are payable only to the facility.

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Correct Usage of Modifiers LT, RT, and 50

Harvard Pilgrim would like to offer providers some reminders regarding the appropriate use of the modifiers LT, RT, 50.

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HPHCURRENT EVENTS

Sign Up for a Webinar on Our Genetic Testing Program

CLINICIAN CORNER

Decreasing Preventable ED Visits and Hospital Readmissions

Coverage of Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

Prior Authorization Required for Brineura

Prior Authorization Criteria Updated for Xgeva

Mental Health Month and Alternative Health Benefits

OFFICE ASSISTANT

Reminder: Report Condition and Value Codes on Institutional Claims

Update to Reimbursement of Codes With PC/TC Indicator of 3

Reimbursement of 3D Rendering of Imaging Studies

Correct Usage of Modifiers LT, RT, and 50

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator