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Claims Processing and Maintenance Schedules

837 Institutional and Professional Claims Processing Schedule

  • Harvard Pilgrim retrieves claim files once a day at 10 a.m., Monday through Friday. Files received after 10 a.m. will be picked up for processing the following business day.
  • 999 acknowledgement reports will be sent immediately after pick-up of the 837 claim file.
  • 277CA reports will be sent no later than 72 business hours from the time of the 837 claim file pick-up.

Weekly Routine Maintenance Schedule

Harvard Pilgrim has weekly routine downtime scheduled from 7:00 p.m. to midnight every Thursday to support maintenance and the development of enhancements for 270/271 eligibility, 276/277 claim status inquiry and 278 referral and authorization.

  • Non-routine downtime is communicated to trading partners by email at least one week in advance.
  • Emergency unscheduled downtime is communicated within one hour following the determination that emergency downtime is needed.

EDI Transaction Availability Schedule

Excluding Harvard Pilgrim’s weekly routine downtime (from 7:00 p.m. to midnight every Thursday), the following transactions are available 24 hours a day*, 7 days a week:

  • 270/271 Eligibility
  • 276/277 Claim Status
  • 278 Referral/Authorization Services

*Exception: Urgent/emergency services

E-transactions submitted during the routine maintenance period will receive an "Unable to respond" or "Not available" message, and may be resubmitted at the end of the maintenance window.

Note: Trading partners submitting patient referral/authorization transactions through NEHEN Express should be aware of the routine maintenance downtime for the eligibility transaction, as this may result in a delayed transaction response.


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E-Contacts
EDI Team
(800) 708-4414
(Option 1; then
press 3)

HPHConnect
(800) 708-4414
(Option 1; then
press 6)

NEHEN
781-907-7210
www.nehen.org


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