The online Provider Manual represents the most up-to-date information on Harvard Pilgrim products, programs, policies and procedures. Information found online may differ from your print version. Contact the Provider Call Center at 1-800-708-4414, if you have questions.
Looking for the Medicare Advantage Provider Manual?
Network Ops & Care Delivery Mgmt.
Local Care Unit (LCU) and Primary Care Provider (PCP) roles, credentialing, and care management.
Information on member rights and responsibilities, determining eligibility, and collecting member payment.
eServices & Online Solutions
Policies and procedures for Harvard Pilgrim’s Web-based transaction service, HPHConnect.
Referral, Notification and Authorization
Policies and procedures related to referral, notification and authorization.
Billing & Reimbursement
Electronic and paper submissions, account reconciliation, and claim submission guidelines.
Payment methodologies that apply to claims in general.
Administrative and clinical appeals, filing limit appeals, and second level appeals.