As a reminder, beginning Nov. 20, 2020 Harvard Pilgrim will be adopting InterQual criteria for commercial medical review of positive airway pressure (PAP) devices for obstructive sleep apnea (OSA). For this new policy, you’ll find that using the HPHConnect portal to submit your authorization request may get you an even speedier response. If you need help getting started, we’re hosting some webinars to guide you step by step in requesting an authorization through HPHConnect.
Electronic questionnaire & on-the-spot approval
The adoption of InterQual criteria includes the use of an electronic authorization questionnaire online, meaning that providers who submit an authorization request on HPHConnect will be prompted to answer a series of questions to determine if the request meets criteria. If so, you can receive an on-the-spot approval.
By using HPHConnect, you can also take advantage of other handy features including the ability to create time-saving templates for the authorization submissions you use most and to attach clinical documentation (up to 8 additional items for sleep DME requests), as well as access to a host of services such as submitting a claim or checking the status of referrals, authorizations, and claims. For more, please refer to this flyer.
Register for a webinar
We’re offering webinars to aid providers and office staff who are new to using HPHConnect for authorization requests. Register by clicking the link of the session you would like to attend below:
New criteria & authorization process
Under the new policy, CPAP devices (E0601) will require two authorization requests: one for the initial three-month rental period and another for the final purchase of the device after the initial three-month rental period is complete.
The respiratory assist devices (E0470 or E0471) may be reimbursed for a count of up to 15 months. The initial authorization is good for a 12-month rental period. If you would like to extend usage for three additional months, it’s necessary to submit a second authorization request.
While Harvard Pilgrim encourages providers to request authorization electronically, we will continue to accept authorization requests by phone (800-708-4414) or fax (800-232-0816).
For more information, please refer to Harvard Pilgrim’s new Positive Airway Pressure Devices for Sleep Apnea Medical Policy. You may view and print the applicable SmartSheet questionnaires via HPHConnect (go to www.harvardpilgrim.org/providerportal, select Resources and then the Upcoming InterQual link).
In addition, please reference these HPHConnect tools:
- HPHConnect User Guides page
- HPHConnect Authorization general training
- HPHConnect and electronic tools overview
Director, Network Operations