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

December 2015

Harvard Pilgrim Welcomes New Employer Accounts and Products for 2016


Harvard Pilgrim is pleased to announce the addition of two new employer accounts — Reliant Medical Group and Atrius Health — effective January 1, 2016.

Reliant Medical Group

As of January 1, we will offer a customized network for Reliant employees through the Reliant Select Care HMO plan. This full-network HMO plan for Reliant employees features a two-tier cost sharing design for physicians only.

Atrius Health

Harvard Pilgrim will also introduce Atrius Health Select, a full-network POS product for Atrius employees only. PCP selection and referrals for specialty care are required. Atrius Health Select members who choose Atrius Health primary care physicians (PCPs) will pay a lower member cost share, when applicable, for services provided within the Harvard Pilgrim network.

Lahey Health Limited HMO

Additionally, effective January 1, 2016, Harvard Pilgrim will be adding a new product to our offerings for Lahey Health employees. Alongside our existing Lahey Select HMO plan, we will now offer the Lahey Health Limited HMO. The new limited-network HMO product will feature two tiers and require members to pick a PCP and seek a referral for care from a specialist.

More information
Please refer to our online provider directory for information on participating providers and cost tier, when applicable, for these new accounts and products. You can recognize members of the Reliant Select Care HMO, Atrius Health Select, and Lahey Health Limited HMO plans by their ID cards.

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HPHCURRENT EVENTS

Harvard Pilgrim Welcomes New Employer Accounts and Products for 2016

CLINICIAN CORNER

PCSK9 Inhibitors: Prior Authorizations and Innovative Contract for Repatha

Pharmacy Updates: 90-day Supplies at Retail and Controlled Substance Limitations

Reminder: Referral Procedure Change for Massachusetts Providers

Reminder: Prior Authorizations for Medicare Advantage via NIA

Administration of Zostavax by Pharmacists

CMS Requirement: Enrolling as a Participating Medicare Provider

Substance Abuse Screening and Referral for Treatment

Reminder: Mandate on Inpatient Care Related to Breast Cancer

OFFICE ASSISTANT

Professional Claim Submission Available on HPHConnect

Improvements in Provider Claims Reporting Tools

Urgent Care Network Requirements

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator