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

October 2019

Highlights
New Pharmacy Benefit Manager Starting Jan. 2020

Harvard Pilgrim has selected OptumRx as the new pharmacy benefit manager for our commercial and Medicare Advantage plans, effective Jan. 1, 2020.

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New Hampshire Formulary Coming in 2020

Beginning Jan. 1, 2020, Harvard Pilgrim is introducing a new drug formulary for the New Hampshire market — the Core NH 5-Tier formulary — which we will implement upon 2020 renewal dates for all fully insured small group and individual customers in New Hampshire.

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How Are We Doing? Tell Us!

We strive to provide exceptional service to our members and provider network, and your feedback gives us insight into what’s working well and what areas offer an opportunity for improvement.

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Synagis for Upcoming RSV Season

With 2019-2020 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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Outpatient Facility Fee Schedule Updates

Effective Jan. 1, 2020, Harvard Pilgrim is updating our current standard outpatient facility fee schedule for acute rehabilitation hospitals, freestanding ambulatory surgery centers, and skilled nursing facilities.

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Important Replacement Claim Billing Reminders

Harvard Pilgrim would like to remind providers of some key points regarding the correct billing of replacement claims.

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HPHCURRENT EVENTS

New Pharmacy Benefit Manager Starting Jan. 2020

New Hampshire Formulary Coming in 2020

How Are We Doing? Tell Us!

Digital ID Cards Coming to Apple Wallet

CLINICIAN CORNER

Update to TMJ Medical Policy

ME Update: Referrals from Out-of-Network Direct Primary Care Providers

Prior Authorization Required for Gamifant

Synagis for Upcoming RSV Season

Pharmacy and Therapeutics Committee Meeting Update

Specialty Pharmacy Program Updates

OFFICE ASSISTANT

Outpatient Facility Fee Schedule Updates

Important Replacement Claim Billing Reminders

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Helen Connaughton,
Director, Network Operations

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator