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?

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.

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Member Care

Information on member rights and responsibilities, determining eligibility, and collecting member payment.

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Product & Product Administration

Information on HPI, Inc. (third party administrator) and a range of products including the Harvard Pilgrim HMO, POS, PPO, national plans and senior plans.

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Referral, Notification and Authorization

Policies and procedures related to referral, notification and authorization.

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eServices & Online Solutions

Policies and procedures for Harvard Pilgrim’s Web-based transaction service, HPHConnect.

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Billing & Reimbursement

Electronic and paper submissions, account reconciliation, and claim submission guidelines.

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Payment Policies

Payment methodologies that apply to claims in general.

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Appeals

Administrative and clinical appeals, filing limit appeals, and second level appeals.

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