Change in denial process for lack of auth
We’re making a change to our claim adjudication process for ancillary services when an authorization is not obtained for the primary service.
Serious Reportable Events policy update
We've updated our Payment Policy for Serious Reportable Events and Provider Preventable Conditions for enhanced clarity and additional resources.
Reminder: Medicare Opt-Out Form required
As a reminder, providers are now required to submit a Medicare opt-out form with their claim in applicable instances.
Working with you as efficiently as possible
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.
Prior authorization
Resources
Visit our one-stop shop for Prior Authorization information and materials. Learn more
Vendor programs
Learn about vendor partners who conduct utilization management for certain services. Learn more
Find a provider
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We invite you to join us in ensuring that our communities have access to high-quality, equitable health care by becoming a participating provider.
View our plans
Learn more about the diverse range of health plans we offer under our legacy brands, Harvard Pilgrim Health Care and Tufts Health Plan.