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

December 2019

Highlights
Reminder: New Pharmacy Benefit Manager in 2020

As we announced in previous issues of Network Matters, Harvard Pilgrim has selected OptumRx to offer pharmacy benefit management services for our commercial and Medicare Advantage plans as of Jan. 1, 2020.

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Reminder: New Address for Submission of Medicare Advantage Claims

As a reminder, as of Jan. 1, 2020, the address for submitting StrideSM (HMO) Medicare Advantage claims is changing.

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Molecular Genetic Testing Code Updates

Harvard Pilgrim requires prior authorization for molecular diagnostic testing, managed through AIM Specialty Health® (AIM), and as part of our annual code update process, we have updated our Molecular Diagnostic Testing Prior Authorization Policy to include new 2020 CPT and HCPCS codes for dates of service beginning Jan. 1, 2020.

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Metabolic Monitoring for Children and Adolescents on Antipsychotics HEDIS Measure

While the cardiovascular disease (CVD) mortality rate has declined significantly in the United States, patients with severe mental illness continue to die prematurely from cardiovascular disease — with an estimated loss of life expectancy of up to 25 years predominantly due to CVD.

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Harvard Pilgrim’s Provider Toolkits

As part of an ongoing commitment to improving provider experience and support, we are developing provider toolkits to assist practices in developing clinical programs and practice standards that improve patient care.

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Help Us Keep Directory Information Up to Date

The Centers for Medicare & Medicaid Services and other regulatory bodies require health plans to maintain and update data in provider directories, and we rely on our providers to review their data and notify us of any changes as they happen to ensure that members have access to accurate information.

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HPHCURRENT EVENTS

NH and ME Telemedicine/Telehealth Mandates Expand Coverage

Fertility Services Coverage Updates for NH, MA, and CT

Reminder: New Pharmacy Benefit Manager in 2020

Reminder: New Address for Submission of Medicare Advantage Claims

CLINICIAN CORNER

Genetic Testing Code Updates

Medicare Advantage: Coding Updates

Prior Authorization for Tumor Treating Field Devices

Cryotherapy Medical Policy Update

Medicare Advantage: Chronic Care Improvement Program for Hypertension

Metabolic Monitoring for Children and Adolescents on Antipsychotics HEDIS Measure

Harvard Pilgrim’s Provider Toolkits

Commercial Formulary Updates for 2020

OFFICE ASSISTANT

Help Us Keep Directory Information Up to Date

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