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StrideSM (HMO) Medicare Advantage Plans

Our Stride (HMO) 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 in providing care to our Stride (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

We’re pleased to announce that we’ve expanded the service area for our Stride (HMO) Medicare Advantage products for 2017 from 17 to 20 counties in Massachusetts, Maine, and New Hampshire.

  • 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 Benefits for 2017

Members can choose from two plan options: Value Rx and Value Rx Plus. Both 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; and annual eye exams and low-cost hearing exams. For 2017, Harvard Pilgrim’s Stride (HMO) Medicare Advantage plans will provide new and enhanced benefits, including:

  • 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