As announced in the April 2015 issue of Network Matters, Harvard Pilgrim will require prior authorization for the following procedures (please click on the links to see the detailed medical review criteria and prior authorization request forms) effective for dates of service on or after July 1, 2015:
Our medical review criteria provide detailed information on what Harvard Pilgrim covers, what documentation is necessary for prior authorization, and associated coding. To request prior authorization, please enter the information about the procedure into our e-business web-based transaction tool HPHConnect or NEHEN and submit the appropriate prior authorization form and medical documentation required by fax to Harvard Pilgrim’s utilization management team at 800-232-0816 at least one week prior to the planned date of service.
You can check the status of your prior authorization request through HPHConnect or NEHEN. Visit Harvard Pilgrim’s provider website to register for HPHConnect.