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

StrideSM (HMO) Medicare Advantage Plans

New Program Rewards Members' Healthy Choices

This month, Harvard Pilgrim is launching 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. Learn more in this Network Matters article.

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 Stride (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 Stride (HMO) Medicare Advantage products for 2018 includes:

  • Massachusetts: Bristol, Essex, Middlesex (excluding 01824, 01826, 01863), Norfolk, Plymouth, Suffolk, and Worcester
  • Maine: Androscoggin, Cumberland, Kennebec, Sagadahoc, and York
  • New Hampshire: Carroll, Cheshire, Grafton, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan

New Plans & Benefits for 2018

Harvard Pilgrim Health Care has introduced two new Basic Rx plans in 2018 to allow more choice for Medicare beneficiaries: Basic Rx in New Hampshire and Basic Rx in Massachusetts. Members can choose from the following plan options: Value Rx (HMO), Value Rx Plus (HMO), and Basic Rx (HMO). Basic Rx (HMO) in New Hampshire has 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 low-cost hearing exams. Harvard Pilgrim’s Stride (HMO) Medicare Advantage plans also offer the following benefits:

  • Over-the-Counter (OTC) benefit — now standard across all plans
  • Eyewear reimbursement — now standard across all plans
  • Preventive dental coverage included at no additional premium cost
  • Robust hearing aid coverage with copayments
  • An expanded $200 fitness reimbursement on all plans (now includes personal training, Yoga, and CrossFit)



Key Resources

Medicare Advantage Provider Portal

Medicare Advantage Provider Portal Registration Form

Quick Reference Guide

Stride (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

Pharmacy Management Utilization Criteria

Step Therapy Requirements

Prior Authorization Requirements

Medicare Advantage Provider Service Center:
8:30 a.m. to 5 p.m.

To mail Medicare claims:
Harvard Pilgrim Health Care, Inc.
c/o Stride Claims Processing
P.O. Box 151288
Tampa, FL 33684-1288

Claims appeal:
Medicare Advantage Provider Appeals
P.O. Box 690546
Quincy, MA 02169