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

February 2015

Urgent Care Network Requirements


Harvard Pilgrim would like to remind providers of certain requirements for participation in our urgent care network and of our policies regarding the addition of new urgent care locations to an existing contract.

Urgent care credentialing requirements

In order to participate in our urgent care provider network, urgent care providers must have a direct agreement with Harvard Pilgrim and meet all state and federal licensing requirements, as well as all Harvard Pilgrim facility credentialing standards. You can find our detailed Facility Credentialing and Recredentialing policy in Harvard Pilgrim’s online Provider Manual.

Remember that every urgent care location must go through our facility credentialing process. Harvard Pilgrim requires that any additional urgent care locations be credentialed according to our standards, and the contract must be amended to include all locations associated with that urgent care tax identification number and National Provider Identifier (NPI) prior to providing care to any Harvard Pilgrim members. The complete process of credentialing an additional location and amending the contract can take up to 45 days. New locations can only be effective on the first day of the month following completion of this process.

Procedures and operational requirements

All urgent care provider entities contracted with Harvard Pilgrim must submit claims under a unique urgent care group NPI, as opposed to the individual clinician’s NPI.

Please note that providers in Harvard Pilgrim’s urgent care provider network are not contracted to provide preventive or routine care, follow-up care, or high-end imaging/radiology services. Our urgent care providers are contracted to treat patients with acute conditions that are immediate in nature and not life-threatening. For any follow-up care, patients should be directed back to their PCPs; urgent care providers should not provide follow-up care themselves or refer a patient to a specialist.

Refer to our Provider Manual for further information regarding network participation requirements for Urgent Care & Walk-In Providers, as well as payment policies for Urgent Care providers.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,
Editor

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Writer

Kristin Edmonston,
Production Coordinator