Prior Authorization

Clinical/Auth. Policies

Access our commercial prior authorization policies, as well as our medical policies for services that do not require authorization, here.

View Clinical/Auth Policies

Referral, Notification and Admin. Policies

Refer to our Provider Manual policies outlining referral, notification, and prior authorization procedures.

View Provider Manual section

Forms

Find the forms you need for our commercial line of business in one handy spot.

View forms

Vendor Programs

Reference information on our vendor partners who conduct utilization management for certain services.

View Vendor programs 

Pharmacy

Access pharmacy clinical coverage criteria and medication request forms.

View Pharmacy

Referral/Auth./Notification Quick Reference Guide

Resource tool for standard commercial HMO, POS, and PPO products, indicating which services may require referral, authorization, or notification.

View QRG

HPHConnect

HPHConnect is Harvard Pilgrim’s highly acclaimed Web-based transaction service for our commercial plans. It’s free, available 24/7, and is HIPAA-compliant. Here you can submit batch claim files, verify patient eligibility, send/receive specialty referrals, submit authorization requests, and more.

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Key Contacts

Provider Service Center (commercial):
800-708-4414

Referral and Authorization Requests:
800-708-4414

Care Management
888-888-4742, x 31035

E-Services/EDI-Direct:
800-708-4414 (Option 1; then 3)

E-Services/HPHConnect Service Center:
800-708-4414 (Option 1; then 6)
Email: provider_ebusiness_services@harvardpilgrim.org