Beginning December 1, 2013, Harvard Pilgrim will offer ElevateHealth, a high-performance limited network HMO product to employers in New Hampshire.
This new option will offer employers in Hillsborough, Merrimack, and Cheshire counties, as well as portions of Grafton and Rockingham counties, access to a defined network of providers. Created through a unique partnership of three local nonprofits — Harvard Pilgrim, Dartmouth-Hitchcock, and the Elliot Health System — ElevateHealth is designed to provide better patient experiences and improved outcomes at an affordable cost.
Not all of Harvard Pilgrim’s contracted providers and facilities participate in the ElevateHealth network. Among those who are in the network, there are two types of participation: “Easy Access” and “Authorized Access.”
Easy Access participating providers may render services to ElevateHealth members and refer them to other Easy Access providers for medically appropriate care, in accordance with all policies and requirements of the standard Harvard Pilgrim HMO product.
For complex or specialty care not available from Easy Access ElevateHealth providers, members may be referred by their PCP to providers participating in the extended Authorized Access ElevateHealth network, provided prior authorization is granted by Harvard Pilgrim. Authorized Access providers should verify with Harvard Pilgrim that authorization has been granted prior to rendering any non-emergency care to ElevateHealth members. Please note that if members go out of network to receive non-emergency care, they will be liable for payment, even if they were referred by their Easy Access physician.
In the event of a medical emergency, any provider should accept ElevateHealth members. Harvard Pilgrim will reimburse for such services at the applicable contracted rates.
You can recognize ElevateHealth members by their ID card, which will indicate “ElevateHealth” in the upper right corner, as in the sample below.
By December 1, 2013, a description of the ElevateHealth product will be available in the “Products and Product Administration” section of the Provider Manual. To view the providers and facilities included in the ElevateHealth network, please refer to the Provider Directory (select the ElevateHealth product search in the directory).