Electronic Tools and HPHConnect

HPHConnect — Harvard Pilgrim’s highly acclaimed Web-based transaction service — provides health plan information for your Harvard Pilgrim patients, 24/7. HPHConnect is HIPAA-compliant and it’s free. If you don’t currently use HPHConnect, we encourage you to REGISTER TODAY (see instructions below)!

Perform the following transactions online:

  • Submit Claim Batch Files (HIPAA 837 Format)
  • Single Claim Direct Data Submission for Professional Claims
  • Verify Patient Eligibility
  • Find the Status of a Claim
  • Send/Receive Specialty Referrals
  • Provide Notification
  • Submit/Receive Authorization
  • View a Patient’s Personal Health Record (PHR)

Access news, information, and reports:

  • Provider Manual, Network Matters, and Provider Directory
  • Code Auditing Reference Tool (CMS-1500 Claims)
  • Drug Formulary and Pharmacy Programs
  • Diagnosis, Procedure, and Revenue Codes
  • PCP Membership Reports
  • Claims Reports

For further questions about HPHConnect, please call 800-708-4414 (Option 1; then press 6) or e-mail Provider_eBusiness_Services@hphc.org.

Sending electronic transactions has a host of benefits — fewer errors, more control over data accuracy, improved cash flow, and lower operating costs. Conduct a broad range of services electronically, including:

  • Eligibility — Verify patient eligibility, determine copayment at the time of service, and prevent inaccurate patient eligibility information — the #1 reason for EDI claim rejection.
  • Referral/notification/authorization —Send and receive referrals in minutes, submit authorization requests and receive instant confirmation of receipt, verify that services are authorized, and support care coordination by ensuring specialist is aware of scope of services/number of visits recommended by PCP.
  • Claims submission and status — submit HIPAA-compliant profession (837P) and institutional (837I) claims directly to Harvard Pilgrim, and send multiple claim inquires at once and receive a reply within 30 minutes.
  • Remittance Advice — Manage accounts receivable with state-of-the-art reporting. The 835 ERA (Electronic Remittance Advice) reports final claim adjudication results to allow the provider system to auto post claim adjudication

Submit electronic transactions directly to Harvard Pilgrim through a preferred e-channel or indirectly through an intermediary.

E-Transactions Preferred Channels

Fast, Easy and Secure. Sign Up for Electronic Funds Transfer Today!

If you are receiving paper checks, make the simple switch to electronic funds transfer (EFT) through Payspan today. Payspan provides you with easy access to your electronic remittance advice (ERAs) and Explanations of Payment (EOP), as well as:

  • Quicker access to funds — Your payments are deposited directly to your bank.
  • Greater convenience & efficiency — EFT eliminates manual processes and you don’t have to worry about lost paper checks.
  • The chance to go green — Going paperless is environmentally friendly.
  • Easy access to payment history — Track, review, and reconcile current or past payments online with Payspan’s easy-to-use payment reports.

Plus, getting signed up for electronic payments is simple!

Reference Tools:

Get Started with EFT Today!