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

June 2019

Highlights
Harvard Pilgrim Network Meeting: Sign Up for our Andover Event

We’re continuing our regional network engagement series in Massachusetts on July 17, 2019 in Andover and invite providers and office staff to register for the event.

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Reminder: Sign Up for a Webinar on Cardiac Diagnostic Imaging Authorization Program

As we noted in last month’s issue of the newsletter, for dates of services beginning July 1, 2019, Harvard Pilgrim will require prior authorization for commercial members for the following non-emergent cardiac diagnostic tests and interventional procedures through National Imaging Associates, Inc. (NIA).

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New Complex Care Program for Medicare Advantage Members

Harvard Pilgrim Health Care is offering a new care coordination program for chronically ill Medicare Advantage members with complex health and social needs.

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Update: Electronic Authorization & Use of InterQual®

On July 15, Harvard Pilgrim is updating our HPHConnect electronic authorization screens — including adding an upload feature for clinical documentation — and expanding our use of InterQual® criteria and tools.

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Update: Maximum Dosages for Medical Drugs

As you may know, Harvard Pilgrim applies industry standard claims edits and does not reimburse for drug dosages above limits in accordance with FDA-approved labeling, accepted compendia, and/or evidence-based practice guidelines for certain medical drugs for our commercial members.

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FreeStyle Libre System: Pharmacy Benefit for Commercial Members

Please be aware that Abbott’s FreeStyle Libre System, a glucose monitoring system for adults with diabetes, covered under the pharmacy benefit for commercial members in all states. To ensure appropriate utilization, prior authorization through Harvard Pilgrim’s Pharmacy Services Department is required. Please note that quantity limits apply.

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Network Matters Archives

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HPHCURRENT EVENTS

Harvard Pilgrim Network Meeting: Sign Up for our Andover Event

Reminder: Sign Up for a Webinar on Cardiac Diagnostic Imaging Authorization Program

GIC Product Updates Effective July 1

New Complex Care Program for Medicare Advantage Members

Child-Adolescent Mental Health Coverage for July 1, 2019

CLINICIAN CORNER

Update: Electronic Authorization & Use of InterQual®

Update: Maximum Dosages for Medical Drugs

Reminder: Notification and Concurrent Review for Inpatient Stays

Vonvendi to be Covered With Prior Authorization

Parsabiv to be Covered With Prior Authorization

Updates to Esophagogastroduodenoscopy Medical Policy

Argus II, CardioMems, and Coflex Not Covered as of Aug. 1

FreeStyle Libre System: Pharmacy Benefit for Commercial Members

OFFICE ASSISTANT

Keep Panel Status and Demographic Information Up to Date

2019 Home Care Seasonal Flu Vaccine Fee Schedule

Clarification: Appropriate Use of Modifier 91

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator