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

May 2015

Reminder of Member Cost Sharing Waiver Policies 

To protect the interests of our providers, Harvard Pilgrim’s Special Investigations Unit (SIU) would like to offer a reminder that routinely waiving or discounting a patient’s copayment, deductible, or co-insurance obligations may be a violation of federal and/or Massachusetts state law.

Certain criminal and civil statutes prohibit offering, paying, soliciting, or receiving any remuneration (including the waiver of member cost sharing) to encourage a person to purchase any good or service for which payment may be made under a health care program.

Exceptions may be made to the definition of “remuneration” for certain waivers of cost sharing obligations that are not advertised or routine, and are made on the basis of individual determinations of financial need or for which reasonable collection efforts have been made. For any questions you may have or for further information about these policies, please contact the Harvard Pilgrim SIU at 877-548-6712.

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Two New Medical Policies Now Available

Complex Case Management Services

Disease Management Programs that Reinforce Physician Treatment Plans

Specialty Pharmacy Program Updates

Reminder of Member Cost Sharing Waiver Policies

Collaboration among PCPs and Behavioral Health Providers


2015 Update of the Home Care Seasonal Flu Vaccine Fee Schedule

Reminder: Ensure That Claims Contain Valid Codes


Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator