As you know, we insourced our behavioral health program for Harvard Pilgrim Health Care Commercial members last year. Behavioral health providers were instructed to submit claims and appeals for Harvard Pilgrim Commercial members directly to Harvard Pilgrim for dates of service on or after Nov. 1, 2023 (the insourcing date), while Optum/United Behavioral Health would manage claims and appeals for dates of service prior to that date.
For further simplification, beginning Nov. 1, 2024, please submit all behavioral health claims and appeals directly to Harvard Pilgrim for Commercial members — even those applicable for dates of service prior to Nov. 1, 2023.
You’ll find guidance on submitting claims in this handy Behavioral Health Quick Reference Guide, as well as in the Billing and Reimbursement section of our Harvard Pilgrim Commercial Provider Manual. For Appeals guidance, please reference the Appeals section of the Harvard Pilgrim Commercial Provider Manual.
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