Now available for Stride: Electronic claims submission with Availity
We’ve established a connection with Availity for 837 electronic claims submission for Harvard Pilgrim Stride (HMO)/(HMO-POS) Medicare Advantage members.
Insights and Updates for Providers
June 2024
Removal of prior authorization requirements for certain procedures
We are removing prior authorization requirements from certain procedures and associated codes in a continued effort to administratively simplify providers’ experience.
2024 Home Care Seasonal Flu Vaccine Fee Schedule
Updates to Harvard Pilgrim’s standard home care seasonal influenza vaccine fee schedule will take effect on Aug. 1, 2024
Coordination of Benefits Quick Reference Guide
This Quick Reference Guide offers providers tips on how to determine which plans have the primary obligation to provide benefits.
Durable medical equipment updates
Point32Health is assessing our reimbursement platforms and making updates to better manage coding for DME and the application of regulatory requirements.
Tufts Health Together: billing for durable medical equipment
We’re offering reminders and clarifying information regarding DME for Tufts Health Together members, including information on MassHealth’s DME service limits.
Updates to facility ER policy and processing rules
Point32Health will begin reviews of facility ER claims to determine the appropriateness of the E/M level of care submitted.
Language interpretation services reminder
Point32Health offers various language interpretation services for members and their providers, who may need assistance beyond their practice’s resources.
Medication Reconciliation – reminder for primary care providers
Point32Health emphasizes the importance of maintaining a standard medication reconciliation procedure to avoid patient medication errors.
Care management Medicare role change
Point32Health is making adjustments to certain care management functions to better coordinate on transitions of care for our members.
New Massachusetts Behavioral Health Resource Directory
The Massachusetts BHHL has launched a resource directory — behavioral health providers are encouraged to confirm their practice is listed.
Good Measures Healthy Weight program launches for members
Harvard Pilgrim Health Care has partnered with Good Measures to offer their Healthy Weight program to members with certain weight/nutrition-related conditions.
Point32Health Medical Necessity Guideline updates
Providers and office staff can refer to this chart to review changes and updates to Point32Health’s Medical Necessity Guidelines.
Point32Health medical drug program updates
Refer to the information in this chart for details on updates to Point32Health’s medical benefit drug prior authorization programs.
MassHealth updates to Unified Formulary
MassHealth recently announced updates to the MassHealth Unified Formulary, effective Aug. 12, 2024, which will apply for Tufts Health Together.
Pharmacy coverage changes
Read about updates to Point32Health’s Pharmacy program and our Pharmacy Medical Necessity Guidelines for Harvard Pilgrim and Tufts Health Plan.
Integrated Point32Health Payment Policy: Clinical Trials
We are introducing an integrated Point32Health Clinical Trials Payment Policy, which outlines information pertaining to Harvard Pilgrim and Tufts Health Plan.
Payment Policy updates: skilled nursing facility care
We’re making Payment Policy updates intended to provide additional clarity and guidance regarding documentation submission expectations for SNF care.
Upcoming training opportunities
We invite you to join one of our many interactive training webinar sessions throughout the month of June — register today!