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

June 2018

Highlights
Introducing New Hampshire POS Open Access Plans

Harvard Pilgrim is introducing a new family of commercial POS products for fully insured and self-insured large groups (100+ employees) in New Hampshire, known as POS Open Access plans, which will launch on July 1, 2018.

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Coverage of Higher Dosage of Lupron Depot for Breast Cancer

Effective immediately, Harvard Pilgrim will provide reimbursement for a higher maximum dosage of Lupron Depot for commercial members being treated for breast cancer.

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Prior Authorization No Longer Required for Cologuard Test

Effective for dates of service beginning June 11, 2018, Harvard Pilgrim will no longer require prior authorization for coverage of the colorectal cancer screening test Cologuard for commercial members.

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Negative Balance and Refund Process Enhancements

Harvard Pilgrim would like to remind providers of the tools and resources available to help navigate our updated negative balance and refund check processes, and to inform you of some recent/upcoming enhancements to the payment summary information in the Payspan printable view, designed to provide more detailed information and allow for greater ease in reconciling your remittance advices.

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Enhanced Processes and Communication with Providers

To improve transparency and efficiency, Harvard Pilgrim is updating our processes and communications with providers relating to provider enrollment change requests and claims rejections.

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HPHCURRENT EVENTS

New Program Rewards Medicare Advantage Patients for Healthy Behaviors

GIC Product Updates Effective July 1

Introducing New Hampshire POS Open Access Plans

Harvard Pilgrim Grant Announcements

CLINICIAN CORNER

Coverage of Higher Dosage of Lupron Depot for Breast Cancer

Benign Prostatic Hypertrophy Medical Policy Updates

Cryotherapy for Prostate Cancer Requires Prior Authorization

Coverage of Fecal Calprotectin Testing

Lutathera Covered with Prior Authorization

Updates to TMJ Prior Authorization Policy

Prior Authorization No Longer Required for Cologuard Test

Follow-up WebEx on Reducing Avoidable Hospital Admissions

OFFICE ASSISTANT

Negative Balance and Refund Process Enhancements

Enhanced Processes and Communication with Providers

Keep Panel Status and Demographic Information Up to Date

Early Intervention Provider Fee Schedule Update

2018 Home Care Seasonal Flu Vaccine Fee Schedule

Documenting Deep Vein Thrombus and Pulmonary Embolism

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator