Harvard Pilgrim continues to regularly monitor the situation in our service areas and update our COVID-19 policies and procedures as needed to support our members and providers. As a reminder, we encourage you to visit the COVID-19 page on our provider website to access resources designed to aid you in conducting operations during the COVID-19 pandemic. We regularly update our Provider Information Sheet with the latest coverage, policy and procedure information, and recent updates include:
- Flu vaccine coverage for children — Harvard Pilgrim is providing $0 cost share coverage for flu vaccines delivered in pharmacies for children age 3 or older. Because the state provides flu vaccines for children (ages 0-18) for in-office pediatric administration, previously Harvard Pilgrim covered flu vaccines delivered at pharmacies with a $0 cost share only for members age 19 or older. For this flu season, we will reimburse for children as young as age 3. This change is one aspect of Harvard Pilgrim’s overall flu vaccine initiative, which includes outreach to educate members on the importance of getting their flu shot and encourage them to get vaccinated.
- Prior authorization — Harvard Pilgrim also extended the suspension of prior authorization on elective admissions at acute care facilities and acute inpatient admissions at acute care, skilled nursing, long-term acute care, and rehab facilities for Massachusetts commercial products for dates of service through Dec. 31, 2020. For all other states and Medicare Advantage products, prior authorization was reinstated for dates of service beginning June 30, 2020.
- Cost-sharing — Cost sharing for telemedicine services resumed for commercial members on Oct. 1, 2020, unless telemedicine is being utilized for COVID treatment. Cost-sharing for COVID-19 treatment — whether delivered in person or via telemedicine— is covered in full without member cost-sharing through Dec. 31, 2020 for all our fully insured commercial, Medicare Advantage, Medicare Supplement and Medicare Enhance plans.
For more information, please refer to the COVID-19 Provider Information Sheet. We hope you find our COVID-19 resources helpful. Please continue to let us know how we can support you by contacting the Provider Service Center at 800-708-4414 or your Provider Relations Consultant or Contract Manager as appropriate.
Director, Network Operations