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

January 2020

Highlights
Submitting Claims for Members of Certain HPI Accounts

Effective Jan. 1, 2020, Boston Scientific and Kindred Healthcare members residing in Massachusetts, New Hampshire and Maine are being administered by Health Plans, Inc. (HPI) in a joint venture with UMR (United Healthcare’s third-party administrator solution).

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HEDIS 2020 Coming Soon: Your Cooperation is Crucial

Each year, the National Committee for Quality Assurance (NCQA) measures the clinical quality performance of health plans across the nation.

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InterQual Criteria for Cryotherapy for Prostate Cancer

Beginning on Feb. 29, 2020, Harvard Pilgrim will be utilizing InterQual® criteria and tools for our existing commercial cryotherapy for prostate cancer prior authorization policy, including an electronic authorization questionnaire that offers a quick and efficient way for you or your office staff to request authorization via HPHConnect.

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Medicare Advantage: Diabetes Updates for March 1

Harvard Pilgrim is updating our StrideSM (HMO) Medicare Advantage Diabetes Management Devices Medical Policy, effective for dates of service beginning March 1, 2020.

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Consultation Service for Treatment of Addiction and Pain

In light of Massachusetts’ ongoing opioid epidemic, Harvard Pilgrim encourages providers to utilize the In light of Massachusetts’ ongoing opioid epidemic, Harvard Pilgrim encourages providers to utilize the Massachusetts Consultation Service for Treatment of Addiction and Pain (MCSTAP), a free service whose mission is to support primary care providers in screening for, diagnosing, treating, and managing the care of all patients with chronic pain, substance use disorders, or both.

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HPHCURRENT EVENTS

Submitting Claims for Members of Certain HPI Accounts

HEDIS 2020 Coming Soon: Your Cooperation is Crucial

CLINICIAN CORNER

InterQual Criteria for Cryotherapy for Prostate Cancer

Prior Authorizations for Xiaflex and Miacalcin

Medicare Advantage: Diabetes Updates for March 1

Updates to Yervoy Medicare Advantage Medical Policy

Pharmacy and Therapeutics Committee Meeting Update

Palliative Care and the MA Coalition for Serious Illness Care

Consultation Service for Treatment of Addiction and Pain

OFFICE ASSISTANT

Connecticut Providers: Termination Requirements

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Helen Connaughton,
Director, Network Operations

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator