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

June 2017

Highlights
Changes to Sleep Diagnostic and Sleep Therapy Program

Harvard Pilgrim is updating our sleep studies and sleep therapies authorization program.

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Review of Inpatient Admissions for Appropriate Level of Care

As you know, Harvard Pilgrim requires notification for all emergent and non-emergent inpatient admissions.

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Reminder: Concurrent Review for Inpatient Stays

As a reminder, Harvard Pilgrim applies a concurrent review program for inpatient admissions to acute care hospitals, acute rehabilitation and long-term acute care hospitals, and skilled nursing facilities to ensure that our members receive evidence-based, well-coordinated, and cost effective health care.

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Reminder: Expanded Medical Drug Prior Authorization Program

As we announced in last month’s issue of Network Matters, beginning July 14, 2017, prior authorizations for select medical drugs for our commercial members will be required through CVS Health–NovoLogix.

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Change in Format of Newly Assigned Practitioner and Provider ID Numbers

Beginning in late July, Harvard Pilgrim will be modifying the format of all newly assigned practitioner and provider identification numbers.

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HPHCURRENT EVENTS

Changes to Sleep Diagnostic and Sleep Therapy Program

Review of Inpatient Admissions for Appropriate Level of Care

Reminder: Concurrent Review for Inpatient Stays

New Publication on Healthy Eating for Older Adults

CLINICIAN CORNER

Reminder: Expanded Medical Drug Prior Authorization Program

ACA Risk Adjustment Data Validation Reminder: Medical Chart Requests

Update to StrideSM (HMO) Medicare Advantage Hysterectomy Criteria

Updates to Bariatric Surgeries Medical Review Criteria

Updates to Varicose Vein Procedures Medical Review Criteria

Update to Cardiac Event Monitors Medical Policy

Prescribing Statins to Members with Diabetes

Members’ Rights and Responsibilities

Biological Effects of Cannabis and Detriments to Adolescent Development

OFFICE ASSISTANT

Telemedicine/Telehealth Payment Policy

Change in Format of Newly Assigned Practitioner and Provider ID Numbers

Credentialing Reminder: Keep Provider Information Up to Date in CAQH

Keep Panel Status and Demographic Information Up to Date

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