New Point32Health webpage
Visit our new integrated provider website, www.point32health.org/provider, to access our new integrated newsletter, our integration FAQ, and our training and events page.
Read more about New Point32Health webpageVisit our new integrated provider website, www.point32health.org/provider, to access our new integrated newsletter, our integration FAQ, and our training and events page.
Read more about New Point32Health webpageWe’ve launched a new provider newsletter that brings you news from Harvard Pilgrim Health Care and Tufts Health Plan in one handy spot. View Insights and Updates for Providers on the Point32Health provider landing page.
Read more about New newsletter: Find the latest updates in our Point32Health newsletterRegister for an upcoming webinar to learn more about Point32Health’s collaboration with Monogram Health for in-home chronic kidney disease (CKD stages 3b-5) and end-stage renal disease (ESRD) care management services for commercial fully insured members.
Read more about Kidney Health Management Program WebinarsHarvard Pilgrim wants to make our provider network aware that we have archived our Commercial Umbilical Cord Blood Payment Policy, and you can now find the pertinent information from this policy, which remains unchanged, on the updated Commercial Obstetrical/Maternity Care Payment Policy.
Read more about Umbilical Cord Blood Payment Policy ArchivedIf you are leaving the Harvard Pilgrim network for reasons unrelated to fraud or quality of care, and you are currently treating a commercial member or covered dependent who may qualify for continuity of care, please assist your patient by completing the Continuity of Care/Transitional Care Request Form.
Read more about Utilizing Our Continuity of Care FormWe’ve developed a new Point32Health MNG for the drug Zynteglo and want to make sure the network is aware that coverage of Zynteglo will require two separate points of contact with Point32Health: a prior authorization request for the drug itself, followed by an acute inpatient notification.
Read more about Zynteglo: Authorization Needed in Addition to Inpatient NotificationWe encourage you to use our new online tool, PromptPA — a quick and easy method for submitting prior authorization requests for both pharmacy benefit and medical benefit drugs.
Read more about PromptPA Now AvailableProviders and office staff can refer to the following chart to review changes and updates to Harvard Pilgrim’s Medical Necessity Guidelines (MNGs), information about newly developed MNGs, and more.
Read more about Medical Necessity Guideline UpdatesEffective for dates of service beginning March 1, 2023, Point32Health will resume our pre-pandemic telehealth reimbursement practices for Harvard Pilgrim Health Care and Tufts Health Plan providers, in keeping with guidance provided by the states we serve.
Read more about Telehealth Reimbursed at Pre-Pandemic Rate as of March 1, 2023In the coming weeks, you may receive a request for copies of medical records for certain patients related to the NCQA’s annual HEDIS project, and we appreciate your assistance in helping us measure clinical quality.
Read more about HEDIS 2023 Coming Soon: Your Cooperation is CrucialWe’ve developed some additional Point32Health HEDIS Tip Sheets, which are designed to offer insight into specific HEDIS measures — one of health care’s most widely used performance improvement tools.
Read more about New Point32Health HEDIS Tip Sheets Now AvailableEffective Jan. 1, 2023, Massachusetts law expands legal protections for practitioners providing services related to pregnancy terminations and gender-affirming care within the state of Massachusetts. Additionally, the law requires coverage of abortion and related services without cost share.
Read more about Protections for Reproductive and Gender-Affirming CareHarvard Pilgrim’s Allergy Testing and Immunotherapy Medical Policy outlines the coverage criteria for allergy immunotherapy for Harvard Pilgrim Commercial members. The policy includes applicable allergy testing and allergy immunotherapy CPT codes, and a list of medically necessary ICD-10 codes.
Read more about Reminder: Allergy Testing and ImmunotherapyPoint32Health, in collaboration with Foundation Medicine, Inc. (FMI), is expanding access to comprehensive genomic profiling for members with advanced solid tumors. We will cover the FoundationOne®CDx and FoundationOne®Liquid CDx CGP tests, with prior authorization, for all eligible members.
Read more about Comprehensive Genomic Profiling for Advanced Solid TumorsHarvard Pilgrim would like to congratulate the 58 physician groups in our Commercial provider network named to our 21st annual Physician Group Honor Roll for the exceptional results they’ve achieved in their approach to disease prevention and the treatment of acute and chronic illness.
Read more about 2023 Physician Group Honor Roll AnnouncedAs a reminder, beginning Jan. 1, 2023, Point32Health, the parent company of Harvard Pilgrim Health Care and Tufts Health Plan, will manage the intake and review of pharmacy and medical drug prior authorization requests.
Read more about Reminder: Requesting Prior Authorization for Medical Benefit DrugsStay updated on the progress we have made in combining Harvard Pilgrim Health Care and Tufts Health Plan under the parent organization, Point32Health, and what’s ahead in 2023 — and register for one of our upcoming informational webinar sessions!
Read more about Register for a Webinar on Latest Integration UpdatesPoint32Health, the parent company of Harvard Pilgrim Health Care and Tufts Health Plan, is launching one combined Point32Health provider newsletter to replace the two legacy organizations’ existing newsletters. Be on the lookout Feb. 1 for the new combined newsletter, called Insights and Updates for Providers.
Read more about Single Newsletter for Improved Provider ExperienceStay updated on the progress we have made in combining Harvard Pilgrim Health Care and Tufts Health Plan under the parent organization, Point32Health, and what’s ahead in 2023 — and register for one of our upcoming informational webinar sessions!
Read more about Latest Integration Updates & WebinarsBoth Harvard Pilgrim Health Care’s Commercial plans and Tufts Health Public Plans have earned Health Equity Accreditation from the National Committee for Quality Assurance (NCQA) — making us the first health plans in New England to receive this honor.
Read more about Point32Health Recognized for Ongoing Commitment to Health EquityFee schedules — including facility, professional (medical and behavioral) and ancillary/allied — are reviewed regularly to ensure that they are comprehensive and consistent with industry standards. This article identifies the timelines for updates to certain fee schedules.
Read more about Point32Health 2023 Fee Schedule UpdatesWe are launching several enhancements to our pharmacy program, effective Jan. 1, 2023, including selecting OptumRx as our pharmacy benefit manager for all products and streamlining utilization management for pharmacy and medical benefit drugs across Point32Health.
Read more about Reminder: Pharmacy Changes for 2023As a reminder, Harvard Pilgrim’s Stride (HMO)/(HMO-POS) Medicare Advantage plans will no longer provide coverage for over-the-counter at-home [FDA-approved or Emergency Use Authorized (EUA) antigen & molecular] COVID-19 tests purchased after Dec. 31, 2022.
Read more about Reminder: Coverage of Free At-Home COVID-19 for StrideAs a reminder, Point32Health is collaborating with Monogram Health for in-home chronic kidney disease (CKD stages 3b-5) and end-stage renal disease (ESRD) care management services for commercial fully insured members.
Read more about Kidney Health Management Program: Sign Up for a WebinarPoint32Health is participating in the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey, which will be administered by the independent research firm SPH Analytics from January through May as a standardized mechanism to measure members’ experience with their health plan and the providers who care for them.
Read more about Consumer Assessment of Healthcare Providers and Systems SurveyAs a reminder, under the Qualified Medicare Beneficiary (QMB) program enrollees are exempt from cost-sharing liability, so all providers are prohibited from charging QMB members for Medicare cost-sharing for covered Parts A and B services.
Read more about Reminder: QMB Members Exempt from Part A/B Cost-SharingHarvard Pilgrim would like to remind providers of our policy regarding Synagis (palivizumab), an injection of antibodies used to protect high-risk infants from severe respiratory syncytial virus (RSV) disease for the 2022-2023 season.
Read more about Synagis Coverage for the 2022-2023 RSV SeasonProviders and office staff can refer to the following chart to review changes and updates to Harvard Pilgrim’s Medical Necessity Guidelines (MNGs), information about newly developed MNGs, and more.
Read more about Medical Necessity Guideline UpdatesHealth plans like Harvard Pilgrim are required to maintain and update data in provider directories — and we rely on providers to review their data and notify us of changes as they happen to ensure that members have access to accurate information.
Read more about Help Us Keep Directory Information Up to DateRegular well visits promote healthy behaviors, prevent risky behaviors, and can detect conditions that could affect adolescents’ development. Well-child visits are as important for adolescents as younger patients, and annual appointments are recommended for this age group (12-21).
Read more about Well-Child Visits and Vaccines for Adolescents