Vendor Prior Authorization Programs

Vendor	Products	Services	Details and contact info
Carelon Medical Benefits Management (formerly AIM Specialty Health)	Harvard Pilgrim Health Care Commercial, Harvard Pilgrim Health Care Stride (HMO/HMO-POS) Medicare Advantage Tufts Health Direct, Tufts Health Plan Together, Tufts Health Plan RITogether, Tufts Health One Care	Genetic and Molecular Diagnostic Testing	View details
EviCore	Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Plan Together, Tufts Health Medicare Preferred (for Harvard Pilgrim members, refer to Evolent below)	Sleep studies PAP supplies	View details
Evolent (formerly National Imaging Associates/NIA)	Harvard Pilgrim Health Care Commercial, Harvard Pilgrim Health Care Stride (HMO/HMO-POS) Medicare Advantage Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Plan Together, Tufts Health Plan RITogether, Tufts Health One Care	Cardiac Diagnostic Tests/Interventional Procedures High-tech diagnostic Imaging Services Select Joint Surgeries (Hip/Knee/Shoulder) Sleep Studies for Harvard Pilgrim Health Care members only (for Tufts Health Plan members, refer to eviCore above) Spine Services (Lumbar Spine Surgery, Interventional Spine Pain Management Services, and Cervical Spine Surgery)	View details
OncoHealth (formerly Oncology Analytics)	Harvard Pilgrim Health Care Commercial, Harvard Pilgrim Health Care Stride (HMO/HMO-POS) Medicare Advantage	Outpatient chemotherapy (infused and/or injected)	View details
Optum/United Behavioral Health	Harvard Pilgrim Health Care Stride (HMO/HMO-POS) Medicare Advantage	Behavioral Health for Stride (HMO)/(HMO-POS) Medicare Advantage	View details
Progeny Health	Harvard Pilgrim Health Care Commercial	Non-routine newborn care (Level II-IV) and all neonatal intensive care unit (NICU) admissions	View details