Reminder: For dates of service beginning Sept. 1, 2020 for our commercial and Medicare Advantage members, prior authorization will be required through Oncology Analytics for outpatient chemotherapy (infused and/or injected) and radiation therapy.

We encourage you to visit our provider website to access a number of up-to-date resources to aid you in conducting operations during the COVID-19 pandemic, including information on coverage of antibody testing and telemedicine/telehealth.

Harvard Pilgrim reimburses nutritional counseling services provided by a contracted nutritionist or registered dietician, when ordered by the member’s PCP or a participating provider. Our commercial Nutritional Counseling Payment Policy outlines coverage of these services.

As a reminder, a replacement claim must completely replace the entire original claim; the information on the replacement claim voids and replaces the previously submitted claim.

Harvard Pilgrim encourages the providers in our network to prescribe statins to members diagnosed with diabetes, and we offer support and coverage to facilitate statin use.

As part of our Chronic Care Improvement Program, Harvard Pilgrim developed a hypertension program to help support you, your practice and your Medicare Advantage patients diagnosed with hypertension.

As of Nov. 1, 2020, Harvard Pilgrim will adopt customized InterQual criteria for medical review of urinary incontenance. As a result, CPT code 57289 will now require prior authorization, while several other codes will be removed from the policy and will no longer require require prior authorization.

Harvard Pilgrim is updating our prior authorization policies for the medications Kymriah and Yescarta for our commercial and Stride Medicare Advantage plans to indicate that these medications are not covered for members previously treated with any CAR-T Therapy.

Effective for dates of service beginning Nov. 20, 2020, Harvard Pilgrim will be adopting InterQual criteria for commercial medical review of positive airway pressure (PAP) devices for obstructive sleep apnea (OSA).

Harvard Pilgrim will be updating our commercial prior authorization policy for implantable neurostimulators to reflect that we are adopting customized InterQual criteria beginning on Sept. 25.

Beginning on Nov. 1, 2020, Harvard Pilgrim will cover hypoglossal nerve stimulation with prior authorization for commercial plans, for the treatment of moderate-to-severe obstructive sleep apnea (OSA) in patients 22 and older for whom continuous positive airway pressure (CPAP) therapy has failed.

With the flu season approaching, it is more critical than ever to emphasize the importance of getting vaccinated to our members — especially those at greater risk of infection and those with risk factors for more severe COVID-19 disease.

Harvard Pilgrim’s fully revamped provider website debuts on Sept. 9th, and features an easy-to-navigate design, improved filtering and search, and an updated look and feel . Content is organized for intuitive navigability so it will be quicker and easier for you and your office staff to find what you need, when you need it.