COVID-19 Information and Resources
12.30.22: Removed reference to StrideSM (HMO)/(HMO-POS) Medicare Advantage coverage of free OTC at-home COVID-19 tests, which ends after Dec. 31, 2022.
9.16.22: Removed previously end dated policies including the Temporary COVID-19 Telehealth/Telemedicine Policy; Medicare Advantage Reimbursement; added clarifying information regarding Bivalent boosters
7.1.22: Removed previously end dated policies related to prior authorization and concurrent review; streamlined existing COVID-19 Treatment information; added information regarding Harvard Pilgrim’s new Telehealth/Telemedicine Payment Policy, effective for dates of service on or after September 1, 2022
05.09.22: Additional coverage updates made to over-the-counter COVID-19 testing for Medicare Advantage members
During the COVID-19 public health emergency (PHE), we have adapted our policies and business operations to support our members in receiving the care, and to aid our provider partners in their efforts to provide patients with safe access to the care, they need. As states lift PHE orders, Harvard Pilgrim Health Care is returning to many pre-pandemic operations and policies. Please see the information below for details on Harvard Pilgrim’s COVID-19 related practices.
The PHE-related policies outlined below apply to our fully insured, Medicare Advantage, Medicare Enhance, and Medicare Supplement products, unless otherwise noted. Coverage for self-insured groups may vary. For any product not specifically stated within the PHE-related policies outlined below, the pre-pandemic policy applies.
Harvard Pilgrim understands the urgency of getting vaccines administered swiftly and effectively and is committed to supporting providers in this important work.
The federal government has purchased the vaccine and is supplying it to vaccinators. Providers will receive the vaccines from state and/or federal health agencies.
With the recent U.S. Food and Drug Administration (FDA) Emergency Use Authorization (EUA) of bivalent formulations of the COVID-19 booster vaccines, individuals aged 12 and older should only be offered the updated (bivalent) mRNA (Pfizer-BioNTech or Moderna) booster. Refer to the CDC for information on COVID-19 vaccinations, including primary doses and boosters.