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

December 2015

Professional Claim Submission Available on HPHConnect

Harvard Pilgrim is adding to the many valuable functions available to providers on HPHConnect. Beginning this month, you can enter professional claims with an “office” place of service online through the convenient electronic transaction tool. In February, this feature will be available for professional claims with all other places of service.

To submit a professional claim, complete all required fields in the “Add Claim” tab in the claims view. Begin by identifying the member as you do in other parts of the application: selecting the patient from the patient list.  Then select or search for the servicing provider; add all applicable diagnosis codes (the application will indicate if the code is ICD-9 or ICD-10); add CPT or HCPCS codes; and select any applicable procedure modifiers.  You will have the opportunity to review the claim on screen for accuracy and then select “Submit” to send the claim to Harvard Pilgrim.
The HPHConnect application will confirm the accuracy of the member and provider information before submitting to Harvard Pilgrim.  Once a claim has been submitted, its status — submitted, pended, paid, or denied — will be viewable in HPHConnect throughout the processing cycle.

For more information, refer to the Professional Claims Submission user guide on Harvard Pilgrim’s provider website. (See the “exceptions” section of this user guide for information specific to Access America.)

To sign up for HPHConnect, visit the HPHConnect Registration page. For any questions about this new feature or any other aspects of HPHConnect, please contact Provider eBusiness Services at Provider_eBusiness_Services@harvardpilgrim.org.

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Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator