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

December 2015

Reminder: Mandate on Inpatient Care Related to Breast Cancer


Providers offering care to Maine members should be aware of a Maine mandate (Maine Public Law Chapter 227 H.P. 246 – L.D. 359: An Act to Assist Persons with Breast Cancer) requiring that inpatient care for a mastectomy, a lumpectomy or a lymph node dissection is covered for a period of time determined to be medically appropriate by the attending physician, in consultation with the member. This information is included in our plan materials to members of our Maine products.

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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