Eligibility inquiry and response are now available to electronic data interchange (EDI) users for Harvard Pilgrim products administered through Health Plans, Inc. (HPI).
The 271 response will include covered services, non-covered services, and services with limitations, copayments, deductibles, coinsurance, and out-of-pocket maximums. Remaining deductible and out-of-pocket maximums are not yet available, but will be in a future release.
For transactions related to plans administered through HPI, providers should call HPI directly at (800) 532-7575 for immediate responses to their questions about the content of the eligibility response.
Technical submission questions will continue to be directed to Harvard Pilgrim. HPI member eligibility and benefits will be available only though the 270/271 response (and applications using the 270/271), and will not be available through HPHConnect.
If you would like to test these modifications, and you require test members, please call Nick Stano at (617) 509-5717 or e-mail Nicholas_Stano@harvardpilgrim.org. Please contact Provider eBusiness Services at firstname.lastname@example.org or (800) 708-4414 (select option 1, and then option 6 from the main menu) with any other questions.