Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Office Support
Products
Provider Manual
Medicare Advantage
Provider Portal
Provider Manual
Prior Authorization Medical Review Criteria
Quick Reference Guide
Medicare Forms
Changes to Your Practice
Research & Teaching
Resources & Links
 
Print    Text Size

Harvard Pilgrim StrideSM (HMO)/(HMO-POS) Medicare Advantage Plans

In this section of our provider website, you’ll find the information and resources you need to work with Harvard Pilgrim Health Care (Harvard Pilgrim) in providing care to our StrideSM (HMO)/(HMO-POS) Medicare Advantage members.

This page offers an overview of the StrideSM (HMO)/(HMO-POS) Medicare Advantage service area and plan options, while our key resources section and navigation menu includes links to the following:

  • Medicare Advantage Provider Portal — An easy-to-use online tool that supports a full range of transactions including claims tracking, patient eligibility verification, authorization request status, and more. You can find registration instructions and the appropriate forms here.
  • Quick Reference Guide (QRG) — An informative document that includes general benefit information, tips on recognizing StrideSM identification cards and verifying eligibility, requesting authorizations and submitting claims, as well as key contact information.
  • Prior Authorization and Referral Chart — Information on services that require referral or prior authorization, as well as links to prior authorization forms.
  • Medicare Advantage Provider Manual — The most up-to-date reference for participating providers, with information on StrideSM (HMO)/(HMO-POS) policies and procedures.
  • Forms — Forms required for prior authorizations, referrals, and appeals.

Service Area

For 2020 the service areas for our StrideSM (HMO)/(HMO-POS) Medicare Advantage plans include one or more of the following counties:

  • Massachusetts: Barnstable, Bristol, Essex, Middlesex (excluding zip codes 01824, 01826, and 01863), Norfolk, Plymouth, Suffolk, and Worcester.
  • Maine: Androscoggin, Cumberland, Franklin, Kennebec, Knox, Sagadahoc, Waldo, and York
  • New Hampshire: Belknap, Carroll, Cheshire, Coos, Grafton, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan

Plan Options

In 2020, Medicare beneficiaries can choose from the following Harvard Pilgrim options:

StrideSM Basic Rx (HMO)
StrideSM Value Rx (HMO)
StrideSM Choice Rx (HMO-POS) NEW!
StrideSM Value Rx Plus (HMO)
StrideSM Gain RxSM (HMO)

All StrideSM Basic Rx (HMO) plans have a $0 monthly premium. All other StrideSM plans offer competitive member premiums, minimal to none PCP copays, and comprehensive benefits including Part D prescription drug coverage, inpatient hospital coverage, routine care and wellness visits, and annual vision and hearing exams

For 2020, Harvard Pilgrim has introduced two new plans that allow more choice for Medicare beneficiaries. The plans are named StrideSM Choice Rx (HMO-POS) and are offered in either Maine or New Hampshire. Harvard Pilgrim’s Point-of-Service (POS) benefit:

  • Accommodates members who travel outside their plan’s service area for fewer than six months.
  • Covers outpatient (Part B) services from out-of-network providers.
    • Routine and preventive care are included
    • Referrals for specialty care are still required from members’ in-network PCPs
    • Cost sharing and prior authorization requirements are the same as for in-network
  • Does not cover elective inpatient (Part A) care from out-of-network providers, including home health agencies and skilled nursing facilities.

Remember, emergency and urgent care are always covered out-of-network regardless of the member’s Medicare Advantage plan.

Supplemental Benefits

Harvard Pilgrim’s StrideSM Medicare Advantage plans also offer the following at no additional premium cost:

  • An annual Wallet Benefit to help cover qualified health and wellness expenses such as a fitness tracker, fitness membership and classes, prescription eyewear, bathroom safety devices (and installation), acupuncture visits, massage therapy, and more*
  • A yearly allowance for eligible over-the-counter (OTC) products, including incontinence supplies, toothbrushes, water flossers, and a digital scale
  • Routine dental coverage such as preventive services, periodontal maintenance, and fillings*
  • Yearly exams to screen for vision and hearing changes
  • Coverage for hearing aids and batteries
  • Curb-to-curb transportation to and from non-emergency medical appointments*

*Benefits vary by plan

Member Incentive Program

Harvard Pilgrim offers a wellness program for our StrideSM Medicare Advantage members that rewards them for making healthy choices. Members can earn merchant gift cards for completing these activities:

  • Annual Wellness Visit
  • Diabetes Eye Exam
  • Colorectal Cancer Screening

Members also have access to a host of health information and tools through CafeWell Rewards.

 

Key Resources

Medicare Advantage Provider Portal

Medicare Advantage Provider Portal Registration Form

Quick Reference Guide

StrideSM (HMO) Medicare Advantage Prior Authorization and Referral Chart

Prior Authorization Request Forms

Referral Form

Claim Review Form

Claims Appeal Form

Claim Overpayment Refund Form

Medicare Compliance Program

Drug Formulary and Utilization Management Criteria

Formulary

Prior Authorization Requirements

Step Therapy Requirements

Medicare Prescription Drug Coverage Determination Form

Medicare Advantage Provider Service Center:
Phone:
888-609-0692
Oct. 1 – March 31,
8 a.m. to 5 p.m. (ET), 7 days a week
April 1 – Sept. 30,
8 a.m. to 5 p.m. (ET), Monday - Friday

To mail Medicare claims:
Harvard Pilgrim Health Care, Inc.
c/o Stride Claims Processing
P.O. Box 93430
Lubbock, TX 79493

Claims appeal:
Fax#: 617-509-4225, or mail to: Medicare
Advantage Provider Appeals
P.O. Box 690546
Quincy, MA 02169