Medical Necessity Guidelines
Access our commercial medical necessity guidelines and authorization policies here.
Referral, Notification and Admin. Policies
Refer to our Provider Manual policies outlining referral, notification, and prior authorization procedures.
Find the forms you need for our commercial line of business in one handy spot.
Reference information on our vendor partners who conduct utilization management for certain services.
Access pharmacy clinical coverage criteria and medication request forms.
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.
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.
Provider Service Center (commercial):
Referral and Authorization Requests:
888-888-4742, x 31035
800-708-4414 (Option 1; then 3)
E-Services/HPHConnect Service Center:
800-708-4414 (Option 1; then 6)