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.

We’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.

Register 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.

Harvard 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.

If 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.

We’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.

We 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.

Providers 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.

Effective 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.

In 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.

We’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.

Effective 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.

Harvard 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.

Point32Health, 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.

Harvard 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.

As 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.

Stay 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!

Point32Health, 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.

Stay 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!

Both 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.

Fee 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.

We 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.

As 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.

As 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.

Point32Health 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.

As 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.

Harvard 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.

Providers 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.

Health 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.

Regular 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).