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

2019 Network Matters archives

December
  • NH and ME Telemedicine/Telehealth Mandates Expand Coverage
  • Fertility Services Coverage Updates for NH, MA, and CT
  • Reminder: New Pharmacy Benefit Manager in 2020
  • Reminder: New Address for Submission of Medicare Advantage Claims
  • Genetic Testing Code Updates
  • Medicare Advantage: Coding Updates
  • Prior Authorization for Tumor Treating Field Devices
  • Cryotherapy Medical Policy Update
  • Medicare Advantage: Chronic Care Improvement Program for Hypertension
  • Metabolic Monitoring for Children and Adolescents on Antipsychotics HEDIS Measure
  • Harvard Pilgrim’s Provider Toolkits
  • Commercial Formulary Updates for 2020
  • Help Us Keep Directory Information Up to Date
November
  • Reminder: New Pharmacy Benefit Manager in 2020
  • New Beth Israel Lahey Health Products
  • Medicare Advantage 2020 Updates
  • MA Ban on Vaping Products and Harvard Pilgrim’s Smoking Cessation Coverage
  • Harvard Pilgrim and Boston Children’s Hospital Combat Adolescent Vaping
  • New Address for Submission of Medicare Advantage Claims
  • Polivy Now Covered With Prior Authorization
  • Updates to Vitamin D Screening and Testing Medical Policy
  • Diabetes Management Devices Medical Policy Update
  • Medicare Advantage: Authorization for Yescarta, Kymriah, and Onpattro
  • Updates to Commercial and Stride Hysterectomy Policies
  • 2020 CPT and HCPCS codes
  • Medicare Advantage: Home Care Reimbursement Methodology
  • NDC Code Required for Professional and Facility Claims
  • Correct Use of Modifiers 24, 25, and 57
  • Reminder: Refer Members to Participating Laboratories
October
  • 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
  • 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
  • Outpatient Facility Fee Schedule Updates
  • Important Replacement Claim Billing Reminders
September
  • Harvard Pilgrim Network Meeting: Sign Up for our Portsmouth NH Event
  • Provider Directory Updates: CAQH Direct Assure Process Launching
  • New Functionality Regarding Medicare Advantage Members
  • ChoiceNet and Hospital Prefer 2020 Tiers
  • Medication-Assisted Treatment and Resources for Providers
  • Updates to New Technology Assessment and Non-Covered Services Policy
  • Promote the Flu Vaccine to Your Patients for the Upcoming Season
  • The Ongoing Epinephrine Shortage and Harvard Pilgrim’s Coverage
  • Billing Reminder: Clinic E&M/Outpatient Services
  • Submitting Claims for Members of Certain HPI Accounts
August
  • Improvements to Claims Processing for Behavioral Health Services
  • SNF Reimbursement Methodology for Medicare Advantage
  • Coverage for Lumoxiti and Libtayo
  • Updates to Commercial Medical Policy for Sandostatin
  • Non-Covered Services: Medical Policy Consolidation
  • Spravato, Zulresso, and Evenity Now Covered for Commercial Plans
  • Coverage of Asceniv Beginning Aug. 1
  • Members’ Rights and Responsibilities
  • Reminder: QMB Members Exempt From Part A/B Cost-Sharing
  • Reminder: Anatomical Modifiers Are Required When Applicable
  • Acupuncture Benefit Information Added to 270/271 Eligibility Response
July
  • July Webinars on Electronic Authorization & Use of InterQual®
  • Harvard Pilgrim Hosts Annual Service Day in New Hampshire
  • Coverage of Elzonris & Panzyga
  • Monitored Anesthesia Care for GI Endoscopic Procedures: Expanded Coverage
  • Update to Spinraza Medical Policy
  • Clarification on Varicose Vein Procedures
  • Yervoy Medical Policy Updates for Sept. 1, 2019
  • Pharmacy and Therapeutics Committee Meeting Update
  • Appropriate Emergency Department Use
June
  • Harvard Pilgrim Network Meeting: Sign Up for our Andover Event
  • Reminder: Sign Up for a Webinar on Cardiac Diagnostic Imaging Authorization Program
  • GIC Product Updates Effective July 1
  • New Complex Care Program for Medicare Advantage Members
  • Child-Adolescent Mental Health Coverage for July 1, 2019
  • Update: Electronic Authorization & Use of InterQual®
  • Update: Maximum Dosages for Medical Drugs
  • Reminder: Notification and Concurrent Review for Inpatient Stays
  • Vonvendi to be Covered With Prior Authorization
  • Parsabiv to be Covered With Prior Authorization
  • Updates to Esophagogastroduodenoscopy Medical Policy
  • Argus II, CardioMems, and Coflex Not Covered as of Aug. 1
  • FreeStyle Libre System: Pharmacy Benefit for Commercial Members
  • Keep Panel Status and Demographic Information Up to Date
  • 2019 Home Care Seasonal Flu Vaccine Fee Schedule
  • Clarification: Appropriate Use of Modifier 91
May
  • Updates to Electronic Authorization & Use of InterQual®
  • HPHConnect: New Resource Page & Referral Update
  • Harvard Pilgrim Awards Nearly $620,000 in Healthy Food Fund Grants
  • Harvard Pilgrim’s Commitment to LGBTQ Equality and Inclusion
  • Clinical Documentation Required for Radiology Services
  • Cardiac Prior Authorization Program for Non-Emergent Tests & Procedures
  • Reminder: NICU Program Begins June 1
  • Reminder on Medical Drugs Obtained through Specialty Pharmacy
  • Updates to Commercial Hemlibra Prior Authorization Policy
  • Khapzory Now Covered with Prior Authorization for Commercial Plans
  • Medicare Advantage: Authorization for Yescarta, Kymriah, and Onpattro
  • Identifying and Treating Postpartum Depression
  • Reminder: Naloxone and Narcan Nasal Spray Coverage
  • Cost-Effective Treatments for Seasonal Allergies
  • Reimbursement for modifier SA & AS
  • Payment Policy Updates: Anesthesia and Pain Management
April
  • Improved Functionality, New Design for HPHConnect Referrals
  • Submitting Claims for Fidelity, Sedgwick, and Nielsen Members
  • Shared Decision-Making Tools for Members and Providers
  • Harvard Pilgrim Partnering with ProgenyHealth on NICU Program
  • Emergency Department Overuse
  • Advance Care Planning Coverage (99497 & 99498)
  • Complex Case Management Services
  • Disease Management Programs Reinforce Physician Treatment Plans
  • Prior Authorization Required for Ilumya
  • Prior Authorization for Cutaquig and Libtayo
  • Prior Authorization Required for Onpattro
  • Alcohol and Drug Use Disorder: Treatment and Helpful Resources
  • Pharmacy and Therapeutics Committee Meeting Update
  • Specialty Pharmacy Program Updates
  • Correct Use of Modifiers 58, 78, and 79
March
  • Harvard Pilgrim Network Meeting: Sign Up for the Mass. Event
  • Update: Emergency Care and Controlled Substances
  • Updates to Medical Policies
  • Udenyca Now Covered with Prior Authorization
  • Reminder: Anser IFX, UST, and VDZ Tests Not Covered
  • Guidance Regarding Procedures Designated as a “Separate Procedure”
  • Keep Panel Status and Demographic Information Up to Date
February
  • HPHConnect for Providers Updated with New Look and Functionality
  • 2018 Physician Group Honor Roll Announced
  • Reminder: UM Decision-Making and Communications
  • Retacrit Now Covered with Prior Authorization
  • Harvard Pilgrim No Longer Covers Cooling Devices
  • Members’ Rights and Responsibilities
  • Medicare Advantage: Report Primary Diagnosis Codes in Primary Position
  • 2019 Fee Schedule Updates
January
  • HPHConnect for Providers Getting a New Look in 2019
  • 2019 Quality Grant Applications Due by Feb. 15
  • HEDIS 2019 Coming Soon: Your Cooperation is Crucial
  • HPI to Administer BMC HealthNet Plan
  • Behavioral Health Survey Results and Convenient New Services
  • New Opioid Safety Edits for 2019 Medicare Advantage Plans
  • Medical Policy Update: Tumor Treating Fields
  • Reminder: Formulas and Enteral Nutrition Require Prior Authorization
  • Updates to Proton Beam Therapy Medical Policy
  • Lumoxiti Now Covered with Prior Authorization
  • TriVisc and Jivi Now Covered with Prior Authorization
  • Pharmacy and Therapeutics Committee Meeting Update
  • Coding Program Launching in January for Medicare Advantage

Network Matters Archives

2019

2018