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

April 2019

Highlights
Improved Functionality, New Design for HPHConnect Referrals

Starting on May 1, you’ll see that we’ve updated HPHConnect for Providers with a new design that makes it even quicker and easier for you and your office staff to submit and check on referral requests.

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Submitting Claims for Fidelity, Sedgwick, and Nielsen Members

Please keep the following information in mind regarding the correct process for submitting claims for Fidelity Investments, Sedgwick Claims Management Services, and Nielsen members.

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Shared Decision-Making Tools for Members and Providers

To aid you and your patients in making health care decisions together, Harvard Pilgrim offers variety of shared decision-making tools from Healthwise on our provider and member websites.

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NICU Program with ProgenyHealth Begins June 1

Harvard Pilgrim is partnering with ProgenyHealth, which specializes in neonatal care management services for the first year of life, to promote healthy outcomes for newborns who are premature and have medically complex cases.

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Emergency Department Overuse

Harvard Pilgrim is committed to improving the quality and value of care for our members, and the physicians in our network are key partners in the pursuit of that goal.

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Correct Use of Modifiers 58, 78, and 79

Harvard Pilgrim would like to offer some reminders regarding the correct use of the modifiers 58, 78, and 79 for our commercial members.

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HPHCURRENT EVENTS

Improved Functionality, New Design for HPHConnect Referrals

Submitting Claims for Fidelity, Sedgwick, and Nielsen Members

Shared Decision-Making Tools for Members and Providers

CLINICIAN CORNER

NICU Program with ProgenyHealth Begins June 1

Emergency Department Overuse

Advance Care Planning Coverage (99497 & 99498)

Complex Case Management Services

Disease Management Programs Reinforce Physician Treatment Plans

Prior Authorization Required for Ilumya

Prior Authorization for Cutaquig and Libtayo

Prior Authorization Required for Onpattro

Alcohol and Drug Use Disorder: Treatment and Helpful Resources

Pharmacy and Therapeutics Committee Meeting Update

Specialty Pharmacy Program Updates

OFFICE ASSISTANT

Correct Use of Modifiers 58, 78, and 79

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator