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

December 2018

Highlights
Webinars for Medicare Advantage Cardiac Prior Authorization Program

There’s still availability to sign up for one of the December webinars that we’re offering if you would like to learn more about our cardiac prior authorization program for Medicare Advantage members.

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Reminder: Prior Authorization for Cervical Spine Procedures

As we announced in last month’s issue of Network Matters, Harvard Pilgrim is expanding our existing musculoskeletal (MSK) prior authorization program with National Imaging Associates, Inc. (NIA) to include non-emergent inpatient and outpatient cervical spine surgeries for commercial and Medicare Advantage members. Effective for dates of service beginning Jan. 1, 2019.

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Medicare Advantage Reminder: Part B vs Part D Drug Benefits

Harvard Pilgrim would like to remind our network that some Part B medical drugs are not eligible for coverage under the Part D prescription drug benefit for Harvard Pilgrim’s Medicare Advantage members. Medical drugs that are covered under Part B are not typically obtained through a pharmacy.

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Promote the Flu Vaccine to Your Patients for the Current Season

As a reminder, it is crucial to emphasize the importance of getting vaccinated to our member population. Because we know patients and their families listen to their providers, Harvard Pilgrim requests that you please promote the flu vaccine to your patients so that they understand how it can help them avoid illness and potential hospitalization.

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Reminder: Anatomical Modifiers Are Required When Applicable

As a reminder, Harvard Pilgrim requires that the appropriate anatomical modifier be appended to claims for applicable procedures. Anatomical modifiers are used to indicate the specific area or part of the body on which a procedure was performed.

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HPHCURRENT EVENTS

Change to Claims Processing for Newborn Care in New Hampshire and Maine

CLINICIAN CORNER

Webinars for Medicare Advantage Cardiac Prior Authorization Program

Reminder: Prior Authorization for Cervical Spine Procedures

Keep Panel Status and Demographic Information Up to Date

Medicare Advantage Reminder: Part B vs Part D Drug Benefits

Mepsevii and Poteligeo Covered with Prior Authorization

Promote the Flu Vaccine to Your Patients for the Current Season

OFFICE ASSISTANT

Enhancements to Claims Editing and Functionality for Medicare Advantage

Reminder: Anatomical Modifiers Are Required When Applicable

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator