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

September 2016

Highlights
Improvements to the Corrected Claim and Second-Level Appeals Processes

We’re pleased to let you know about some improvements in our corrected claim and second-level appeals submission processes.

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Home Base Offers Resources and Trainings for Treating Veterans

Harvard Pilgrim would like to highlight the valuable resources available to providers through Home Base, a Red Sox Foundation and Massachusetts General Hospital program.

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New Coverage Reflects Importance of Advance Care Planning

Advance care planning is a crucial step to ensure that patients get the medical care they want when they are unable to speak for themselves due to illness or injury.

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New Policy: Monitored Anesthesia Care for GI endoscopy

Based on the clinical evidence that most upper and lower endoscopic gastrointestinal (GI) procedures can safely and comfortably be performed with sedation administered by the gastroenterologist, Harvard Pilgrim has developed a new medical policy for monitored anesthesia care (MAC) for upper and lower GI procedures.

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Reminder for Medicare Providers: Sign Up to Use the Stride Portal

If you are a participating provider for our Medicare Advantage Stride products, please be sure that you are registered for Harvard Pilgrim’s easy-to-use Medicare Stride-specific portal.

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HPHCURRENT EVENTS

Improvements to the Corrected Claim and Second-Level Appeals Processes

Home Base Offers Resources and Trainings for Treating Veterans

CLINICIAN CORNER

Updated Policy: Fecal DNA Testing for Colorectal Cancer

New Coverage Reflects Importance of Advance Care Planning

Updated Policy: Vaccine and Immunization

New Policy: Monitored Anesthesia Care for GI endoscopy

Prior Authorization Required for Lipitor

Synagis for Upcoming RSV Season

Anxiety and School Refusal in Children

OFFICE ASSISTANT

Reminder for Medicare Providers: Sign Up to Use the Stride Portal

Bill Diagnosis Codes in the Primary Position for Preventive Services

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator