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

February 2017

Highlights
Newborn Level II-IV/NICU Admission Notification Policy

For dates of admission on or after April 15, 2017, Harvard Pilgrim is requiring notification from the servicing providers for non-routine newborn care (level II-IV) including all admissions to neonatal intensive care units (NICU).

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Prior Authorization for Non-Emergent Transportation

Effective for dates of service beginning May 1, 2017, Harvard Pilgrim is requiring prior authorization for all non-emergent transportation, including air (fixed-wing) and ground transportation (i.e. ambulance, wheelchair van).

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Provider Manual Update and Balance Billing

Harvard Pilgrim has updated the Collecting Member Payment policy in our commercial online Provider Manual to provide greater clarity regarding the appropriate method of billing for health services.

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Moderate Sedation Reimbursement for GI Endoscopic Procedures

As we reported in the December issue, as of April 1, 2017, Harvard Pilgrim will provide separate reimbursement for the following newly released codes for moderate sedation when it is provided by the same physician performing the procedure that the sedation supports: 99151, 99152, 99153, and G0500.

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HPHCURRENT EVENTS

2016 Physician Group Honor Roll Announced

CLINICIAN CORNER

Newborn Level II-IV/NICU Admission Notification Policy

Prior Authorization for Non-Emergent Transportation

Update: Expanded Coverage for Esophagogastroduodenoscopy (EGD)

GERD: Endoscopic Treatments Medical Policy Updated

Updates to Artificial Cervical Disc Replacement Policy

Reminder: 90-day Supplies at Retail

Coordinating Care to Manage Weight Gain in Behavioral Health Patients

OFFICE ASSISTANT

Provider Manual Update and Balance Billing

Moderate Sedation Reimbursement for GI Endoscopic Procedures

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator