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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

May 2014

Spine Management and Prior Authorization: Sign Up for a Webinar

As we announced in last month’s issue of Network Matters, Harvard Pilgrim will require prior authorization on selected spinal surgeries and injections, beginning July 1, 2014. Throughout June, we’re offering webinars for providers who would like to learn more about this change.

Harvard Pilgrim has chosen National Imaging Associates, Inc. (NIA) to implement the spine management and prior authorization program for members of our HMO, POS, PPO, and Access America products*. Prior authorization will be required for the following:

  • Non-emergent inpatient and outpatient spine surgeries:  lumbar microdiscectomy; lumbar decompression (laminotomy, laminectomy, facetectomy, and foraminotomy); and lumbar spine fusion (arthrodesis)
  • Non-emergent outpatient interventional spine pain management services: spinal epidural injections; paravertebral facet joint injections or blocks; paravertebral facet joint denervation [Radiofrequency (RF) Neurolysis]

Ordering physicians will be responsible for obtaining prior authorization for all of the procedures and spine surgeries listed above. On June 23, NIA will begin taking prior authorization requests for these surgeries and procedures with dates of service of July 1, 2014 and beyond.

Enroll in a Webinar
Provider education webinars will be offered on the following dates:

  • Monday, June 9 — 12 p.m.
  • Wednesday, June 11 — 8 a.m. and 12 p.m.
  • Tuesday, June 17 — 8 a.m. and 12 p.m.
  • Thursday, June 19 — 4 p.m.
  • Thursday, June 26 — 8 a.m. and 12 p.m.

These webinars will include detailed clinical and procedural information (the clinical guidelines being used, clinical information required for a prior authorization, steps for obtaining prior authorization, response time, etc), and you’ll have an opportunity to receive answers to any questions you may have. You will need a computer with Internet access to view the educational materials presented during the webinar.

To enroll in one of these sessions, please call NIA at 800-327-0641 at least one week prior to the session you plan to attend. After you sign up for the webinar, you will receive an email confirmation that includes your toll-free dial-in number, access code, and web meeting address.

More Information Available
For more detailed information on this program, you may also refer to the following materials developed by Harvard Pilgrim and NIA:

If you have any further questions, please contact the Provider Service Center at 800-708-4414.

* For members residing in Massachusetts, New Hampshire, Maine, and Connecticut. Pending regulatory approval in Rhode Island.

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Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,

Kristin Edmonston,
Production Coordinator