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

November 2015

Hospital Discharge Notifications Reminder

As a reminder, to expedite claims processing and initiate care management services to members following an inpatient stay, Harvard Pilgrim requires all acute care facilities to submit a daily list of discharged members, including newborns and NICU cases; we will accept the current format of your discharge census.

To submit discharge data electronically, email Discharges@HarvardPilgrim.org with a password-protected file using your NPI or existing password for the discharge file (please inform Harvard Pilgrim of the password used for the protected file). Alternatively, you can FAX your discharge file to 617-509-1159, “Attn: Care Management Dept.”

For details on the information required in daily discharge reports, refer to the "Acute Care Facility Discharge Notification Requirements" section in the “Access to Care” section of our Medicare Advantage Provider Manual. The discharge notifications requirement applies to our Medicare Advantage products as well as our commercial products.

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Network Matters Archives

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Medicare Advantage Stride (HMO) Updates and Reminders

Prior Authorizations for Medicare Advantage Stride (HMO) via NIA

Medicare Advantage Stride (HMO) Gender Reassignment Services

New 2016 Medicare Advantage Stride (HMO) Benefits

Hospital Discharge Notifications Reminder

ICD-10 Reminder and Provider Support

HCAS Credentialing Best Practices Guide Now Available

Affordable Care Act and Risk Adjustment


Reminder: Referral Procedure Change for Massachusetts Providers

Identifying and Treating Postpartum Depression

Prior Authorization Required for Rexulti

Prior Authorization Required for Zecuity

P&T Committee Updates

Specialty Pharmacy Program Updates


Reminder: Keep Panel Status Up to Date

Reminder: Bill National Drug Codes (NDC) For Unlisted Drugs


Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator