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

January 2009

Automatic EDI claims routing to Health Plans, Inc.

Effective immediately, providers submitting Electronic Data Interchange (EDI) claims through a clearinghouse for members whose products are administered by Health Plans, Inc. (HPI) may use payer ID 04271 to submit claims directly to Harvard Pilgrim for routing to HPI.

Providers already submitting claims directly to Harvard Pilgrim can now use their direct connection to Harvard Pilgrim to submit claims for routing to HPI. EDI submitters will no longer be required to separately transmit claims to HPI. This new service will improve administrative efficiency by reducing the number of claims returned for resubmission.

When EDI claims are sent to Harvard Pilgrim, providers will receive the normal Harvard Pilgrim EDI claim acknowledgment reports—CS837 and 277ACK—and claims will go through Harvard-Pilgrim-standard edit validations.

Please note that this service applies only to EDI claims. Paper claims sent to Harvard Pilgrim for members whose products are administered by HPI will be returned for resubmission to HPI.

Please call HPI at (800) 532-7575 with any questions about adjudication and payment of claims.

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First Seniority Freedom update

Collection of members’ race, ethnicity and language data

Recredentialing change for Maine clinicians

Use of electronic health care records may lower paid malpractice claims

Automatic EDI claims routing to Health Plans, Inc.


Answers about Harvard Pilgrim’s cervical cancer screening reports

Sharing clinical data vital to quality care

Preventive programs for behavioral health issues

P&T Committee update

First Seniority Freedom prescription drug update

Members’ Rights and Responsibilities


Reminder: Authorization requirements for the treatment of varicose veins

Fee schedule updates 

Oxygen code update

Claims editing software update

Obstetric ultrasound policy update

Non-covered services update


Upcoming Provider Trainings

Network Matters Archives

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