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).