In recent issues, we announced some updates on reaching us by phone, email, and fax, and are providing the following clarifications and reminders.
- Portal is recommended — We encourage you to use our secure provider portal for quick and efficient processing of your referrals and authorization transactions.
- Authorization, notification and referral submission
- For behavioral health services — Effective Jan. 1, 2025, we will only accept requests for behavioral health referrals, notifications, and authorizations by phone for certain service types for Harvard Pilgrim Commercial members. Our Provider Services team will be able to guide you accordingly when you call. We’re updating our automated messaging for the Provider Service Center in conjunction with this change, and behavioral health providers will no longer have a separate menu of options but should follow the prompts for all providers. Please submit your requests by portal or fax.
- For medical services — On Nov. 1, 2024, we discontinued accepting requests for authorization, notifications, and referrals by phone for Harvard Pilgrim Health Care Commercial members. These requests should be submitted via our secure portal or fax. Refer to the bullet below for additional information and exceptions.
- For status updates and assistance — We encourage use of our secure provider portal HPHConnect to check the status of your referral, notification, or authorization request. However, providers may inquire about existing referrals, notifications, and prior authorizations by phone. In addition, if portal and fax are not available you may contact the Provider Service Center by phone for assistance.
- Portal registration — If you aren’t currently registered for Harvard Pilgrim’s secure portal, HPHConnect, please follow these registration instructions. With HPHConnect, you’ll be able to perform a host of transactions online 24/7, including verifying patient eligibility, checking the status of a claim, submitting/receiving authorization, providing notification, sending/receiving referrals, and submitting batch claim files or single professional claims. For further assistance with HPHConnect, contact the eBusiness team at [email protected].
- Fax numbers for Harvard Pilgrim — If you opt to utilize for referrals, please submit them to 617-509-4297. For authorizations, please utilize the fax number listed on the applicable Medical Necessity Guideline, Medical Drug Medical Necessity Guideline or Pharmacy Medical Necessity Guideline.