For dates of service beginning Sept. 1, 2022, Harvard Pilgrim’s Interim Telemedicine/Telehealth Payment Policy (COVID-19 Pandemic) will be retired, and a new, permanent Commercial Telehealth/Telemedicine Payment Policy will take effect.

As a reminder, Point32Health has made the difficult decision to withdraw Harvard Pilgrim Health Care fully insured commercial products in Connecticut as of January 1, 2023, and we are working closely with providers to ensure a smooth transition.

We’ve developed a series of Point32Health HEDIS Tip Sheets to offer insight into specific HEDIS measures, aid your practice in optimizing HEDIS scores, and help identify opportunities to improve patient care.

Boston Children’s Hospital now participates in Harvard Pilgrim’s Focus Network – MA, which will provide greater access to care for our pediatric members — particularly critical in light of the closure of Tufts Children’s Hospital at Tufts Medical Center.

In light of the CT contrast dye shortage, we would like to remind providers that prior authorization is not required for inpatient and emergency department studies. For non-urgent studies, NIA is following the guidance of the American College of Radiology.

Effective for dates of service beginning Sept. 1, 2022, prior authorization will be required for coverage of the medication Aduhelm (HCPCS J0172) for members of Harvard Pilgrim’s Stride (HMO) Medicare Advantage plans.

Effective for dates of service beginning Sept. 1, 2022, Harvard Pilgrim will require prior authorization for coverage of the medications Leqvio (HCPCS J3490) and Releuko (HCPCS C9096) for members of our Commercial plans.

Harvard Pilgrim requires prior authorization for coverage of chimeric antigen receptor (CAR) T-cell immunotherapies, now including the medication Carvykti for members of our Commercial and Stride (HMO) Medicare Advantage plans.

Harvard Pilgrim has expanded the criteria for coverage of the spinal muscular atrophy (SMA) drug Spinraza for our Commercial members, to allow for greater patient access.

Effective for dates of service beginning Sept. 1, 2022, Harvard Pilgrim is updating our Commercial Varicose Vein Procedures Medical Policy, which will be known as the Procedures for the Treatment of Symptomatic Varicose Veins Medical Policy.

Harvard Pilgrim is updating our Commercial New Technology Assessment and Non-Covered Services Medical Policy, effective for dates of service beginning Sept. 1, 2022.

Harvard Pilgrim is updating our Commercial medical policy for hypoglossal nerve stimulation for obstructive sleep apnea, effective for dates of service beginning Sept. 1, 2022.

Harvard Pilgrim has updated our Commercial Emergency Care Payment Policy for informational purposes only, to offer additional guidance on coding for professional and facility evaluation and management (E/M) codes.

Harvard Pilgrim is updating our Commercial Laboratory and Pathology Payment Policy to reflect correct coding related to specimen collection for COVID-19 testing, effective for dates of service beginning Sept. 1, 2022.