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

September 2017

Highlights
Update: Commercial Medical Transportation Policy

Based on feedback from our provider partners, Harvard Pilgrim is updating and clarifying our policy requiring prior authorization for non-emergent transportation for our commercial members, which went into effect in May.

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ChoiceNet and Hospital Prefer 2018 Tiers

New tier assignments for Harvard Pilgrim’s ChoiceNet and Hospital Prefer plans take effect on Jan. 1, 2018, and last month Harvard Pilgrim mailed letters notifying physician groups and hospitals whose tier changed of their new tier assignments for these products.

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Prior Authorization for Select Hip, Knee, and Shoulder Surgeries

Effective December 1, 2017, Harvard Pilgrim is requiring prior authorization through National Imaging Associates, Inc. (NIA) for certain non-emergent inpatient and outpatient hip, knee, and shoulder surgeries for commercial members enrolled in our HMO, PPO, and POS products.

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Update to Inpatient Acute Medical Admissions Payment Policy

Harvard Pilgrim’s Inpatient Acute Medical Admissions Payment Policy outlines reimbursement for inpatient acute medical admissions for services rendered at Harvard Pilgrim-contracted facilities and the timeframe for what Harvard Pilgrim considers to be a readmission for diagnosis-related groups (DRGs) and global case rate facilities.

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Payspan and Electronic Funds Transfer Reminders

Harvard Pilgrim would like to offer a few reminders related to Payspan and registering for electronic funds transfer (EFT).

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HPHCURRENT EVENTS

Update: Commercial Medical Transportation Policy

ChoiceNet and Hospital Prefer 2018 Tiers

Correction: Practitioner and Provider ID Number Format

CLINICIAN CORNER

Prior Authorization for Select Hip, Knee, and Shoulder Surgeries

Changes to Bariatric Surgery Coverage in Connecticut

Updates to Sinus Surgeries Medical Review Criteria

Collaboration among PCPs and Behavioral Health Providers

OFFICE ASSISTANT

Update to Inpatient Acute Medical Admissions Payment Policy

Payspan and Electronic Funds Transfer Reminders

Keep Panel Status and Demographic Information Up to Date

ACA Risk Adjustment Data Validation: Medical Chart Requests Underway

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator