Harvard Pilgrim Health Care Home
  Learn more.
  Sign up for HPHConnect.
Medical Management
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Office Support
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
Print    Text Size

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

December 2015

Reminder: Referral Procedure Change for Massachusetts Providers

As a reminder, Harvard Pilgrim’s modifications to our current referral procedures take effect on January 1, 2016. Under the updated policy, Massachusetts primary care physicians (PCPs) must submit requests for referrals to Harvard Pilgrim for members of our HMO or POS products prior to the services being rendered.

While the current process of submitting the PCP name and National Provider Identifier (NPI) of the referring provider is still required, it will no longer be accepted as proof of referral in Massachusetts as of January 1, 2016. Prior to delivering services, the specialist, or other servicing provider, should ensure that a referral has been made and approved.

You can initiate referral requests through a variety of channels: electronically or by phone, mail, or fax. We encourage electronic submission — through HPHConnect or NEHEN, or NEHENNet — for timeliness and efficiency. Or, if you prefer, referrals can be submitted by fax to 800-232-0816, by phone to 800-708-4414, or by mail to:

Harvard Pilgrim Health Care
Referral and Authorization Unit
1600 Crown Colony Drive
Quincy, MA 02169

When submitting a referral by fax or mail, please complete the referral form for our commercial products found in our Provider Manual. For more detailed information on the referral process and requirements, please refer to the article in the November issue of Network Matters. If you have additional questions, please contact the Provider Service Center at 800-708-4414.

Email this article to a colleague   

Network Matters Archives

Download printer-friendly version


Harvard Pilgrim Welcomes New Employer Accounts and Products for 2016


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


Professional Claim Submission Available on HPHConnect

Improvements in Provider Claims Reporting Tools

Urgent Care Network Requirements


Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator