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

October 2018

Highlights
Medicare Advantage: Expansion and New Benefits for 2019

As open enrollment for StrideSM (HMO) Medicare Advantage begins this month, we want to update you on our expanded service area and new product benefits for 2019.

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CAQH Solution Chosen to Improve Provider Directory Accuracy

As a member plan in HealthCare Administrative Solutions (HCAS), Harvard Pilgrim is participating in efforts to institute a centralized process for providers to review their demographic data and report changes to ensure provider directory accuracy.

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Synagis for Upcoming RSV Season

With 2018-2019 respiratory syncytial virus (RSV) season approaching, Harvard Pilgrim would like to remind providers of our policy regarding Synagis (palivizumab), an injection of antibodies used to protect high-risk infants from severe RSV disease.

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Hospital-Based Clinic and Treatment Room Commercial Payment Policy Updates

In a hospital-based clinic setting, Harvard Pilgrim reimburses the physician for the evaluation and management (E&M) services, and any facility charges should be billed under a clinic revenue code in the 051X or 052X series.

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Update to Filing Limit for Replacement Claims

Harvard Pilgrim has updated our commercial Replacement Claim Billing Policy to extend the timeframe for providers to submit a replacement claim.

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Network Matters Archives

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HPHCURRENT EVENTS

Medicare Advantage: Expansion and New Benefits for 2019

CAQH Solution Chosen to Improve Provider Directory Accuracy

Introducing Maine POS and HMO Open Access Plans

SaveOn Program Now Called Reduce My Costs

CLINICIAN CORNER

Updates to Antiemetic Therapy Medical Review Criteria

Updates to Molecular Genetic Testing Clinical Guidelines

Synagis for Upcoming RSV Season

OFFICE ASSISTANT

Hospital-Based Clinic and Treatment Room Commercial Payment Policy Updates

2019 CPT and HCPCS codes

Update to Filing Limit for Replacement Claims

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator