Provider Manual for Medicare Advantage

The online Medicare Advantage Provider Manual represents the most up-to-date information on Harvard Pilgrim’s Medicare Advantage StrideSM (HMO) products, programs, policies, and procedures. This manual sets forth the policies and procedures that providers participating in the Harvard Pilgrim Medicare Advantage network are required to follow. Contact Medicare Advantage Provider Service Center at 888-609-0692, if you have questions.

Network Operations

Information about our plan, provider roles and responsibilities, and credentialing and recredentialing.

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Member Rights & Responsibilities

General coverage information, member rights and responsibilities, privacy information, member protections regulations, and submission of encounter data.

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Referral, Notification & Authorization

Referral policies and procedures; authorization and notification procedures.

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Billing & Reimbursement

Claims submission, billing information, coordination of benefits, claims review and audit, and reimbursement methodology.

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Payment Policies

Payment methodologies that apply to Medicare Advantage StrideSM claims in general.

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Access to Care

Advance directive information, care delivery programs, accessibility, member transfer, and release of medical records.

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