We encourage providers to utilize our electronic and fax options when requesting authorization, providing notification, and sending or receiving specialty referrals, and want to make you aware of changes related to other options we offer.
Modified process for authorizations, notifications, and referrals
To align our submission process for authorizations, notifications, and referrals across Point32Health, we are modifying the way in which we take in these important requests.
- Effective Nov. 1, 2024, we will no longer accept medical authorizations, notifications, or referrals for Harvard Pilgrim Health Care Commercial members via phone. Following this date, these requests should be submitted via fax or via our secure provider portal, HPHConnect.
- Effective Jan. 1, 2025, we will only accept behavioral health notifications and authorizations by phone for certain service types for Harvard Pilgrim Commercial members (see attached list). Our Provider Services team will also be able guide you accordingly when you call.
Our electronic and fax options offer greater speed, consistency, and operational efficiency. In addition, these changes help align our Harvard Pilgrim referral and authorization processes with other regional health plans and with our Tufts Health Plan line of business, which does not accept referral and authorization requests via phone.
Provider Service Center email discontinued
As we announced in the last issue of the newsletter, after evaluating the efficiency and effectiveness of various communications vehicles, we are discontinuing use of the Provider Service Center email, [email protected], for all lines of business as of Oct. 1, 2024.
While the Provider Service Center currently operates an email box, usage information has shown that this is not an efficient mechanism for resolving provider inquiries. In most cases, these inquiries are moved to the electronic portal or telephone contact to enable the team to gather the necessary secure information to resolve an issue.
On our Harvard Pilgrim secure provider portal, HPHConnect, you’ll still have the option of reaching the Provider Service Center directly via our Message Center.
Utilizing our secure portals
We encourage the use of our secure portals for a variety of transactions. You can submit specialty referrals and request authorizations securely, quickly, and easily using our secure portals — and authorization requests may be approved more quickly, often on the spot.
We are also introducing enhancements to the registration process for HPHConnect — aimed at streamlining the registration process and shortening registration turnaround times.
If you are not currently registered for HPHConnect, you can get started by completing this online enrollment form and following these registration instructions. To register for the Tufts Health Plan secure portal, follow these registration instructions.
Resources to guide you
If you are new to our secure portals, we have a variety of resources available to assist you with conducting these transactions, including:
- Secure portal user guides — Our HPHConnect user guides walk you step-by-step through conducting common transactions on the Harvard Pilgrim secure portal. Topics include submitting referral, authorization and notification entries for a variety of specific services, performing referral/authorization searches, checking the status of a referral/authorization transaction, and more. Visit the Provider Training guides page to view these resources, as well as Tufts Health Plan secure portal user guides.
- Quick videos — If you need assistance with getting started with HPHConnect, we offer a variety of quick videos on topics such as registering for HPHConnect and checking referral or authorization status in HPHConnect.
- Harvard Pilgrim Commercial Provider Manual — The Referral, Notification and Authorization section of our Commercial Provider Manual offers the most-up-to date information on policies and procedures.
- Medical Necessity Guidelines — Our Medical Necessity Guidelines detail coverage criteria and note the applicable fax number to use when requesting authorization for our lines of business.
Annmarie Dadoly,
Senior Manager, Provider Communications
Joseph O’Riordan,
Editor
Susan Panos, Ellen Gustavson, Ryan Francis, Stephen Wong,
Writers
Kristin Edmonston,
Production Coordinator
Kristina Cicelova,
Graphic Designer