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

April 2016

New Medicare Advantage FDR Compliance Program Website Available

As part of our Medicare Compliance Program, Harvard Pilgrim has created a new website to assist our providers and other business partners (known as first tier entities) in understanding how we do business and to outline your responsibilities in providing services to Harvard Pilgrim and our Medicare members.

On the Medicare Advantage FDR Compliance Program webpage, you’ll find our Medicare Standards of Conduct for First Tier, Downstream, and Related Entities (FDRs); information on CMS-required compliance and Fraud, Waste and Abuse (FWA) training; Office of Inspector General (OIG) screening requirements; and how you can report compliance concerns.

If you are a provider who participates in our Medicare Advantage network, please review this documentation and share it with the appropriate employees. Medicare Advantage contracted providers  are required to complete the Compliance Program Attestation found on the website and return it to Harvard Pilgrim by September 30, 2016 by email at Compliance_Programs@harvardpilgrim.org or by mail to:

Michael Comerford, Medicare Compliance Officer
Harvard Pilgrim Health Care, Inc.
93 Worcester Street
Wellesley, MA 02481

If you are contracted through a practice, provider organization, or facility, this form should be completed by the administrator of that entity.

If you have any further questions, please contact Harvard Pilgrim Medicare Compliance Officer Michael Comerford at Compliance_Programs@harvardpilgrim.org.

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Network Matters Archives

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Important Referral Reminders for PCPs

New Medicare Advantage FDR Compliance Program Website Available


Vaccine Policy: Updates Regarding State-Supplied Vaccines

Clinical Policy and Prior Authorization Updates

Upcoming Clinical Reviews: Give Us Your Feedback

Updates to Harvard Pilgrim’s Nexium Coverage

Diabetes Outreach Program for Medicare Advantage Members

Harvard Pilgrim’s Commitment to Health Equity

P&T Committee Updates

Specialty Pharmacy Program Updates

Reminder Regarding Annual Well Visits


Benefit from the Convenience of Electronic Funds Transfer

Reminder: Use of Non-Participating Ambulance Providers


Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator