Provider Manual
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?
Commercial Manual
Network Ops & Care Delivery Mgmt.
Local Care Unit (LCU) and Primary Care Provider (PCP) roles, credentialing, and care management.
Member Care
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.
Appeals
Administrative and clinical appeals, filing limit appeals, and second level appeals.