As you may be aware, the Budget Control Act of 2011 imposed across-the-board reductions in federal spending, including a 2 percent sequestration reduction applied to Medicare fee-for-service payments to providers and Medicare Advantage payments to health plans by the Centers for Medicare & Medicaid Services (CMS) in April 2013. Similarly, Harvard Pilgrim will be implementing a 2 percent reduction in claims payments to providers participating in Medicare Advantage StrideSM (HMO), effective January 1, 2015.
Harvard Pilgrim will apply this reduction so long as CMS applies its sequestration reduction. These reductions will be reflected in the "withhold" column listed on your explanation of payment. If you have further questions, please contact the Medicare Advantage Provider Service Center at 888-609-0692.