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

July 2015

New Medical Policy for Urine Drug Testing 

Harvard Pilgrim has developed a new medical policy for urine drug screening, which is used to monitor drug misuse or abuse during substance abuse treatment and in pain management settings.

Harvard Pilgrim covers urine drug testing in the context of pain management and substance abuse treatment when it is medically necessary. The new Urine Drug Testing Medical Policy, which is effective immediately, details the situations in which Harvard Pilgrim considers urine drug testing medically necessary, as well as the situations in which it is not medically necessary. The policy also includes a reminder that medical record documentation should include the rationale for ongoing testing and indicate how results are being used to manage the member’s treatment. For detailed information, please refer to the Urine Drug Testing Medical Policy posted on our provider website.

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ICD-10 Information Available Online

Reminder: Now Offering GIC POS and HMO Products


Genetic Testing Medical Policy Updated

New Medical Policy for Urine Drug Testing

Coverage of Oral Devices for Obstructive Sleep Disorder

Update: Outpatient Rehabilitative Therapies Policy

Acute Pain Management and Safe Opioid Prescribing

Reminder: Naloxone Available Without Member Cost Sharing

Vivitrol as Part of a Substance Abuse Treatment Plan

P&T Committee Updates

Specialty Pharmacy Program Updates

Medicare Quality Improvement: Reducing Preventable Readmissions

Diabetes Outreach Program for Medicare Advantage Members


Payment Policy Update: Coverage of CPT 99211

Payment Policy Update: Counseling Risk Factor Reduction


Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator