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

October 2016

Highlights
Medicare Advantage Updates: Expansion and Prior Authorization Policies

As open enrollment for Stride (HMO) Medicare Advantage plan begins this month, we want to provide you a few updates, including information about our expanded service area, new product benefits for 2017, and additional prior authorization and clinical medical policies.

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Habilitative Benefit Requirement and Rehabilitative Benefit Changes

Effective January 1, 2017, in support of the Affordable Care Act’s (ACA’s) essential health benefits requirement, Harvard Pilgrim will cover habilitative services and devices for all non-grandfathered, commercial plans offered in the individual and small group markets, both on and off the exchanges in all states.

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Reminder: Billing for Additional Antepartum E&M Visits

Harvard Pilgrim has updated our Obstetrical/Maternity Care Payment Policy to provide greater clarity, and would like to remind providers of our policy regarding the submission of claims for additional antepartum evaluation and management (E&M) visits.

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Outpatient Fee Schedule Updates

Effective January 1, 2017, Harvard Pilgrim is updating our current standard outpatient facility fee schedule for acute rehabilitation hospitals, freestanding ambulatory surgery centers, and skilled nursing facilities.

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Network Matters Archives

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HPHCURRENT EVENTS

Harvard Pilgrim Among NCQA’s Highest-Rated Private Health Plans in the U.S.

Medicare Advantage Updates: Expansion and Prior Authorization Policies

Harvard Pilgrim Introduces ElevateHealth Options in New Hampshire

Habilitative Benefit Requirement and Rehabilitative Benefit Changes

CLINICIAN CORNER

Medicare Prescriber Enrollment Deadline Updated

Reminder: Billing for Additional Antepartum E&M Visits

2017 CPT and HCPCS codes

Update to Formulas and Enteral Nutrition Prior Authorization Policy

Updates to Cardiovascular Disease Risk Tests Policy

Medicare Advantage Blood Glucose Monitoring Supplies

P&T Committee Updates

Specialty Pharmacy Program Updates

Updates to Clinical Medical Policies

ADHD Diagnosis and Follow-up Care

OFFICE ASSISTANT

Outpatient Fee Schedule Updates

Assisting our Nurse Case Managers with Requests for Information

Keep Panel Status and Demographic Information Up to Date

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