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

March 2017

Highlights
National Healthcare Decisions Day Emphasizes Advance Care Planning

Advance care planning is a crucial step to ensure that patients get the medical care they want when they are unable to speak for themselves due to illness or injury.

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Stelara Coverage and Prior Authorization Criteria Updated

Effective for dates of service on or after April 15, 2017, Harvard Pilgrim is updating our Stelara commercial and StrideSM (HMO) Medicare Advantage prior authorization policies to include additional criteria for the use of Stelara to treat plaque psoriasis and psoriatic arthritis and to add Crohn’s disease as a covered indication.

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Update: Pudendal Nerve Decompression Coverage

Harvard Pilgrim considers pudendal nerve decompression experimental and investigational for the treatment of pudendal neuralgia.

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Appropriate Use of Modifier 91

Harvard Pilgrim would like to provide clarification regarding appropriate and inappropriate use of modifier 91 (repeat clinical diagnostic laboratory test).

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HPHCURRENT EVENTS

National Healthcare Decisions Day Emphasizes Advance Care Planning

The Foundation’s Report on Transgender Health Care in Greater Boston

CLINICIAN CORNER

Stelara Coverage and Prior Authorization Criteria Updated

Update: Pudendal Nerve Decompression Coverage

Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) HEDIS Measure

OFFICE ASSISTANT

Appropriate Use of Modifier 91

Harvard Pilgrim Expanding Authorization ID Numbers

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