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StrideSM (HMO) Medicare Advantage Plans

New Program Rewards Members' Healthy Choices

Harvard Pilgrim now offers a wellness program for our StrideSM (HMO) Medicare Advantage members that encourages and rewards them for making healthy choices. Members can earn merchant gift cards for completing screenings and they have access to a host of health information and tools through CafeWell Rewards, an online and app-based program.

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

This page offers an overview of the StrideSM (HMO) 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 tracking claims, verifying patient eligibility, reviewing the status of authorization requests, and more. You can find registration instructions and the appropriate forms here.
  • Quick Reference Guide — A handy 1-page sheet that includes tips on recognizing members 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 Harvard Pilgrim Stride (HMO) policies and procedures.
  • Forms — Forms required for authorization, referral, and appeals.

Service Area

Our service area for our StrideSM (HMO) Medicare Advantage products for 2019 includes:

  • Massachusetts: Barnstable, Bristol, Essex, Middlesex (excluding 01824, 01826, 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

New Plans & Benefits for 2019

Harvard Pilgrim Health Care has introduced two new plans in 2019 to allow more choice for Medicare beneficiaries: Basic Rx in Maine and Gain RxSM in New Hampshire. Members can choose from the following plan options: Basic Rx (HMO), Value Rx (HMO), Value Rx Plus (HMO), and Gain RxSM (HMO). Basic Rx (HMO) plans in New Hampshire and Massachusetts have a $0 premium. All other plans offer a competitive member premium, minimum PCP copays, and comprehensive benefits including: Part D Prescription drug coverage; inpatient hospital coverage; routine care and wellness visits; annual eye exams and hearing exams. Harvard Pilgrim’s StrideSM (HMO) Medicare Advantage plans also offer the following benefits:

  • An annual Wallet Benefit allowance to help cover qualified health care expenses such as fitness, eyewear, acupuncture visits, massage therapy, and more*
  • Yearly allowance for over-the-counter (OTC) products
  • Preventive dental coverage included at no additional premium cost*
  • Yearly routine and hearing exams
  • Robust hearing aid coverage with copayments
*Benefits vary per plan selection



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


Prior Authorization Requirements

Step Therapy Requirements

Medicare Prescription Drug Coverage Determination Form

Medicare Advantage Provider Service Center:
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