For 24 years, Harvard Pilgrim Health Care has used its annual Physician Group Honor Roll to acknowledge physician groups for achieving exceptional results in their approach to disease prevention and the treatment of acute and chronic illness for both adult and pediatric patients.
Effective for dates of service beginning April 1, 2026 for our Harvard Pilgrim Health Care Commercial members, Point32Health will apply level of care reviews to elective inpatient medical admissions, including elective oncology admissions for the administration of chemotherapy drugs.
As valued partners in the care of our members, providers have the option to appeal a coverage denial if they disagree with the result of a Point32Health utilization management (UM) decision.
Learn about HPHConnect, our secure web-based transaction service for Harvard Pilgrim products, including how to register and submit transactions.
Learn about the web-based transaction service for Tufts Health Plan products, including how to register and submit transactions.
Visit the EDI page to learn more about trading partners, getting set up for electronic transactions and to access companion guides.
Visit our electronic funds transfer (EFT) page to get started with receiving your reimbursement electronically.
Learn about vendor partners who conduct utilization management for certain services.
We invite you to join us in ensuring that our communities have access to high-quality, equitable health care by becoming a participating provider.
Learn more about the diverse range of health plans we offer under our legacy brands, Harvard Pilgrim Health Care and Tufts Health Plan.
