Broker & employer resources

On April 17, Point32Health, the parent organization of Harvard Pilgrim Health Care and Tufts Health Plan, identified a cybersecurity ransomware incident that has impacted our Harvard Pilgrim Health Care systems.

System limitations impact our Harvard Pilgrim Health Care commercial and Medicare Advantage Stride℠ (HMO)/(HMO-POS) plans. Tufts Health Plan, Tufts Medicare Preferred, Tufts Health Public Plans and CarePartners of Connecticut systems have not been affected.

After detecting the unauthorized party, we proactively took our Harvard Pilgrim systems offline to contain the threat. We have notified law enforcement and regulators and are working with third-party cybersecurity experts to conduct a thorough investigation into this incident and remediate the situation.

During the course of our investigation, we determined that the files at issue may contain personal information and/or protected health information for Harvard Pilgrim current and former subscribers and dependents, and current contracted providers. Harvard Pilgrim has now begun the process of notifying individuals whose information may potentially have been involved in the incident.

For more information, please refer to the Notice of Data Security Incident on the Harvard Pilgrim Health Care website.

As of May 12, thanks to the work of our internal technical experts working with leading third-party cybersecurity experts, a number of our core Harvard Pilgrim Health Care systems are expected to come back online over the next several weeks. We are currently going through the internal IT and business validations. As we have said throughout this process, we are exercising caution and have not and will not bring any systems back online until we have full confidence in their security.

Point32Health is taking the necessary steps to ensure that our systems and applications are secure before they are brought back online. We have implemented several security measures, such as Endpoint Detection and Response (EDR), Managed Detection and Response (MDR), Microsoft Active Directory security hardening, server rebuilds, vulnerability management, privileged access reviews, account password changes, security enhancements for end user computers, and firewall rule reviews. We are confident it is safe to connect with the systems we are bringing back online.

While we still have work to do to begin operating business as usual, we will begin to bring the systems that support the following activities back online over the next couple of weeks:

• Member eligibility;
• Provider payments;
• Payments to other partners, such as our brokers and vendors; and
• Account/member renewals and enrollments.

More detailed information on when these functions will be ready for use is coming soon.

As we continue to make progress, we will share additional information. We appreciate your continued patience.

Our top priority is continuing to provide access to care for our members. Point32Health is committed to providing coverage for all members during this time.

We are in the early stages of the investigation, which will take time to complete. In tandem, we are working around the clock to return to business as usual as quickly as possible. We are committed to keeping you informed and will provide you with regular updates as new information is available.

We are communicating with brokers and employers via email on an ongoing basis to keep our constituents informed. Currently, communication with members is primarily through our public website, www.point32health.org, until we’re able to communicate with them through our normal channels. For commercial members, we are also providing information to their employers, as needed, to share with them.

We are providing regular updates to employers and brokers through emails and FAQs posted on the Point32Health website. Our emails to employers and brokers reinforce that our top priority is, and remains, providing access to care for our members, and that Harvard Pilgrim will continue to pay for health care services. This includes our policy to waive utilization management requirements for most covered services. We also sent employers a letter to share with their employees providing information to help them obtain the services they need, including urgent care, behavioral health care and prescriptions. We will continue to update this page as new information is available. Members should not be billed for the services.  Please contact Member Services if you have been billed or are asked to pay for the service.

It is important to continue to emphasize that members can receive health care services. We have communicated to providers that they should provide care if a member presents a Harvard Pilgrim Health Care (HPHC) member ID card, even though providers are currently unable to verify eligibility or cost sharing. Once we resume providing eligibility files, providers can then bill members for the applicable cost sharing amount. If it is determined, after having received care, that the member was not eligible on the date of service, Point32Health will nonetheless reimburse providers for the services.

Effective April 15, 2023 and until further notice, we have waived all prior authorization (PA) requirements and related utilization management (UM) processes for all non-pharmacy medical and behavioral health benefits for Harvard Pilgrim Health Care members.

Please keep in mind that the waiver of PAs and related UM requirements applies only during this system outage.  As soon as the PA & UM capabilities resume, we will share updated information and next steps on this website and through other communication channels.

The prior authorization waiver above does not apply to pharmacy benefit and medical benefit drugs. This process has not changed, as our pharmacy systems continue to function normally.

If members have questions, please have them reach out to their provider and/or our Member Services teams.

• Medicare Advantage Stride℠ (HMO)/(HMO-POS) plan members: Call 888-609-0692 (TTY: 711). Representatives are availableMonday through Friday from 8 a.m. to 8 p.m.
• All other Harvard Pilgrim plan members: Call 888-333-4742 (TTY: 711). Representatives are available Mondays, Tuesdays and Thursdays from 8 a.m. to 6 p.m.; Wednesdays from 10 a.m. to 6 p.m.; and Fridays from 8 a.m. to 5:30 p.m.

We are currently unable to process any reimbursement requests for Harvard Pilgrim members, including requests submitted via paper forms. Therefore, we recommend that subscribers wait until our systems are restored to submit their reimbursement requests. As a reminder, subscribers may submit their 2023 reimbursement requests up until March 31, 2024 or December 31, 2024, depending on their specific plan.

Yes.

Yes.

No files are going into or out of Harvard Pilgrim Health Care systems, including EDI, HRA/HSA and data warehouse extracts. Tufts Health Plan is both receiving and sending data files.

Yes. The SmartStart team can be reached by calling 888-333-4742 or emailing us at smartstart@point32health.org. Wait times may be longer than normal.

Effective immediately, we have established a temporary process to enroll new Harvard Pilgrim members. This applies to new groups and existing groups who are adding new members. This process should be used for enrollments until systems are restored:

• Complete all fields of the enrollment template  or enrollment form  (or work with your broker to complete) and email it via secure/encrypted email to employer_updates@point32health.org. Employers or brokers will receive an email from the same email address to verify eligibility when a member requests enrollment.
• Temporary member ID cards will be generated daily as enrollments are processed. Members with urgent access to care issues will be able to receive an eligibility letter immediately.
• Once the enrollment is processed, members should receive a temporary member ID card within 14 calendar days. The temporary ID cards look similar to current Harvard Pilgrim cards; however, the ID number will start with P3 rather than our standard HP. Permanent ID cards will be issued once the system outage is resolved.

Please note: We are in the process of notifying providers and pharmacies regarding the use of the temporary ID numbers to help ensure easier access to care for our members.

Providers may submit claims using the temporary ID number; however, we cannot process claims and update accumulators (e.g., deductibles and out-of-pocket maximum amounts) until a permanent ID number is assigned.

Harvard Pilgrim members who require urgent access to care should call the phone number on the back of their ID card. If they do not have their ID card available, they should call Member Services at 888-333-4742 (TTY: 711).

Members should not be prevented from getting pharmacy services in general, although some specific issues have been reported. Members will be able to seek reimbursement for prescriptions if they paid out of pocket as a result of any delayed eligibility updates.

For commercial brokers and/or employers, urgent questions should be submitted to MyServiceTeam@point32health.org. Members should call the number on the back of their ID card for urgent access to care issues. If they do not have their ID card available, they should call Member Services at 888-333-4742 (TTY: 711).

Optum has been notified not to deny for eligibility.

If a new member’s enrollment had not yet been processed when our systems went down, they may be denied at the pharmacy. We are actively working with Optum to load newly enrolled members into OptumRx. If members are having difficulties filling a prescription, they should call the number on the back of their ID card, and a representative will work to ensure that their medication can be filled. If they do not have their ID card available, they should call Member Services at 888-333-4742 (TTY: 711).

During the system outage, DoD will accept Harvard Pilgrim members without verifying eligibility or applying cost share. Members will be billed for their cost share once benefits and eligibility can be verified. Members should not be billed for the services. Please inform members to contact Member Services if they have been billed or are asked to pay for the service.

During the outage, existing Harvard Pilgrim Health Care group members will continue coverage under their current plan. New members can be added to the current plan via the new member enrollment process shared on April 26 via email and included in these FAQs. Once the outage is resolved, groups will be moved retroactively to the group’s anniversary date, implementing any plan changes and applicable rates that were agreed to upon renewal. This approach applies to all groups, including those who would normally move from small group to large group upon their anniversary date. Billing will be adjusted to reflect the new rate; however, it may take a few billing cycles for this to be reflected after the outage is resolved.

While we are not aware of any misuse of personal information and protected health information as a result of the incident, out of an abundance of caution, Harvard Pilgrim is offering complimentary access to two (2) years of credit monitoring and identity theft protection services through IDX to potentially impacted individuals. We also recommend that individuals remain vigilant, monitor, and review their financial and account statements and explanations of benefits, and report any unusual activity to the institution that issued the record and to law enforcement.

For more information, please refer to the Notice of Data Security Incident on the Harvard Pilgrim Health Care website.

Members who have additional questions may contact the dedicated assistance line at IDX, which can be reached at 888-220-5517 (toll free), Monday through Friday from 9:00 AM to 9:00 PM ET, excluding U.S. holidays.

Billing and payment information is available in the member FAQ section.

Although providers cannot submit claims for Harvard Pilgrim Health Care commercial members at this time, Point32Health is committed to restoring the timely distribution of payments to providers. We are working diligently to reinstitute regular claims processing and payments to our Harvard Pilgrim Health Care commercial network. We will provide specific information to our HSA/HRA vendors about the status of claims processing, data extracts, and weekly files once our systems are available.

Tufts Health Plan small groups who are scheduled to migrate to Harvard Pilgrim Health Care will remain on their current Tufts Health Plan until our systems are restored. At that time, we will migrate these members over to a Harvard Pilgrim Health Care plan with a retroactive anniversary date.

The incident has had minimal impact on Health Plans, Inc. (HPI) business operations. HPI’s resources for employers, members and partners including its website and call centers remain operational as usual. However, there may be a delay in some billing and claims processes that are performed by Point32Health/Harvard Pilgrim Health Care.

We have made the decision to delay insourcing our behavioral health program, which was scheduled to occur on July 1 for our Harvard Pilgrim Health Care commercial members, so that we can focus fully on restoring systems affected by the cybersecurity ransomware incident. Originally scheduled to start July 1, we expect our new integrated and insourced model to launch in fall 2023. Please note that any new ID cards planned for July 1 due to behavioral health insourcing will not be distributed; however, new ID cards resulting from other changes (i.e., plan changes) may still be distributed.

Yes, until the date that insourcing takes effect, Harvard Pilgrim Health Care will maintain our contract with Optum/UBH to continue to provide behavioral health services for Harvard Pilgrim Health Care members. Until further notice, Optum/UBH is waiving referral, authorization and notification requirements for behavioral health services for members of Harvard Pilgrim Health Care commercial and Medicare Advantage Stride^SM (HMO)/(HMO-POS) plans. Optum/UBH is processing behavioral health claims and reimbursing providers without interruption.

All Harvard Pilgrim Health Care members in New England and nationwide will be able to continue to see their providers as they do today based on their current health plan designs.

Clients and/or brokers should notify their account executives if they wish to terminate their existing policy. However, we are unable to process terminations at this time. Once our systems are restored, any requests for terminations will be made retroactively to the requested termination date.

HPI’s prior authorization requirements remain in place, and HPI can process prior authorization requests for approval/denial.

HPI can process claims that have been priced by UnitedHealthcare. However, for members on UnitedHealthcare plans or UMR plans that seek services in the Harvard Pilgrim Health Care service area, HPI sends those claims to Harvard Pilgrim Health Care for pricing.  As a result, those claims currently cannot be processed. The last file that was priced by Harvard Pilgrim Health Care was for April 12, 2023.

We are able to identify members who are in active care management with Harvard Pilgrim Health Care care managers through systems that have been integrated as part of the larger integration of Tufts Health Plan and Harvard Pilgrim Health Care. Our care managers are outreaching to these members to continue to deliver needed assistance with any ongoing care issues. As always, all members are encouraged to reach out to their providers for any immediate health concerns. Should a member wish to refer themselves to care management, they can contact us at (866) 750-2068.

At this time, we are exploring what, if any, accommodations we may extend related to invoicing claims to self-insured clients. We will continue to share information about the claims process as it becomes available and appreciate your patience. As we bring our systems online, we expect to process a higher volume of claims and provide additional service to address an anticipated increase in inquiries.

During the outage, Brokers assisting individuals and families looking for coverage should contact MEIndividual@point32health.org in Maine and NHIndividual@point32health.org in New Hampshire.

During the system outage, no Harvard Pilgrim members or groups will be terminated due to lack of payment.

May premium invoices for employer groups in the April 15 billing cycle were generated and sent out prior to the outage. This includes paper bills, paperless and online billing. However, unless they were downloaded prior to the outage, paperless and online billing statements are not available to view.

May premium invoices for employer groups in the April 20 or April 25 online billing cycle were not generated due to the system outage. These groups will be invoiced during the next invoice cycle, which is currently to be determined. During the system outage, we cannot provide copies of invoices.

Premium payment due dates have been extended to May 31.

Currently, we do not have access to that information. However, you can use your most recent invoice and pay the amount in the “Current Premium” field, and it will be reconciled in a later billing cycle.

We do not currently have a timeline. We will share more information as soon as it’s available.

During the system outage, Harvard Pilgrim can only accept payments via check or wire transfer.

No, automatic payments will not be taken until our systems are restored. During the system outage, Harvard Pilgrim can only accept payments via check or wire transfer.

All payments received during the outage will be processed prior to running automatic payments. If you paid your premium by check, nothing will be deducted from your account.

All payments received during the outage will be posted once the system is restored. Until then, you can confirm we received your payment by checking with your banking institution.

During the system outage, we cannot check the status of any refund requests.

For Harvard Pilgrim customers who have been terminated for non-payment and are seeking reinstatement or are in the process of trying to be reinstated, please contact your Account Services representative for options.

We extended the grace period to May 31 for any payments due by April 30, including those due to avoid termination. You can make a payment via mail or wire now to bring your account current and avoid termination of the policy. Once systems are restored, you can make a payment online.

HPI is accepting claims from providers. HPI cannot process claims for payment, since HPI claim files are sent to Harvard Pilgrim Health Care for network pricing. Other financial transactions for billing and payment remain unaffected.

We are currently unable to process debit card payments. May premium payment due dates have been extended to May 31, 2023. Payment can be accepted via check or wire transfer.

No, Harvard Pilgrim Health Care (HPHC) is not partnering with any third party-vendors to administer online payments during this outage. We continue to work to ensure our systems are restored safely so we can accept payments directly as part of our standard practice. Please note: If an employer group or member chooses to use a third-party billing service voluntarily, HPHC is not liable for any associated activity, such as delays in payments being processed.

The broker portal is currently inaccessible. To enroll new members, you can complete a paper application form and submit it by using one of the following options:

• Secure email to Medicare Broker Support at medicarebrokersupport@point32health.org
• Fax Harvard Pilgrim Health Care Medicare Advantage Stride℠ applications to: 813-513-7302
• Fax HPHC Insurance Company Medicare Supplement applications to: 617-509-4262

Harvard Pilgrim Health Care Medicare Advantage Stride^SM (HMO)/(HMO-POS) applications are still being processed as normal and members will receive a member ID card from us. If you need assistance looking up a new enrollee’s member ID number and effective date, please contact broker support at medicarebrokersupport@point32health.org.

We are unable to process and activate new HPHC Insurance Company Individual Medicare Supplement enrollment applications. We are working diligently to identify a solution to resolve this issue. Once our enrollment and billing system is back up and running, and as permitted under applicable regulatory requirements, eligible applicants will have retroactive coverage dated back to May 1. During this time, we ask you to remind your clients they can continue to utilize their Medicare coverage, since claims must go to Medicare as the primary payer first.

Plan documents and resources for Harvard Pilgrim Health Care Medicare Advantage Stride^SM (HMO)/(HMO-POS) members are available within the member resources section.

Harvard Pilgrim Health Care Medicare Advantage Stride^SM (HMO)/(HMO-POS) members who require urgent access to care should call 888-609-0692. Members should not be prevented from getting pharmacy services in general, although some specific issues have been reported. Members will be able to seek reimbursement for prescriptions if they paid out of pocket as a result of any delayed eligibility updates.

How are urgent issues being managed?

For Medicare brokers, urgent questions should be submitted to medicarebrokersupport@point32health.org.

Member questions?

• Harvard Pilgrim Health Care Medicare Advantage Stride^SM(HMO)/(HMO-POS) members should call 888-609-0692 (TTY: 711).
• Harvard Pilgrim Health Care Medicare Supplement members should call 877-907-4742 (TTY: 711).
• Harvard Pilgrim Medicare Enhance members should call 888-333-4742 (TTY: 711)

Optum has been notified not to deny for eligibility.

If a new Harvard Pilgrim Health Care Medicare Advantage Stride^SM (HMO)/(HMO-POS) plan member’s enrollment had not yet been processed when our systems went down, they may be denied at the pharmacy. If members are having difficulties filling a prescription, they should call the number on the back of their ID card, and a representative will work to ensure that their medication can be filled. If they do not have their ID card available, they should call Member Services at 888-609-0692 (TTY: 711).

• Harvard Pilgrim Health Care Medicare Supplement members: 877-907-4742 (TTY: 711)
• Harvard Pilgrim Medicare Enhance members: 888-333-4742 (TTY: 711)

Yes. Harvard Pilgrim Health Care Medicare Advantage Stride^SM (HMO)/(HMO-POS) members can use the online drug lookup to find covered drugs and participating pharmacies.

No, Harvard Pilgrim Health Care (HPHC) is not partnering with any third party-vendors to administer online payments during this outage. We continue to work to ensure our systems are restored safely so we can accept payments directly as part of our standard practice. Please note: If an employer group or member chooses to use a third-party billing service voluntarily, HPHC is not liable for any associated activity, such as delays in payments being processed.

Harvard Pilgrim Health Care Medicare Advantage Stride

Complete a paper application and send it to us by secure email or fax.

• Secure email: medicarebrokersupport@point32health.org
• Fax: 813-513-7302

HPHC Insurance Company Medicare Supplement

Complete a paper application and send it to us by secure email or fax.

• Secure email: medicarebrokersupport@point32health.org
• Fax: 617-509-4262

 Tufts Health Plan Medicare Advantage HMO/PPO and CarePartners of Connecticut HMO/PPO:

• Utilize your Broker Personalized URL (PURL)
• Complete a paper application and send it to us by secure email or fax:
  • Secure email: medicarebrokersupport@point32health.org
  • Fax: 617-972-9475

Tufts Health Plan Medicare Advantage HMO/PPO, CarePartners of Connecticut HMO/PPO and Harvard Pilgrim Health Care Medicare Advantage  Stride^SM

Call Medicare Broker Support at (833) 984-2387, Monday through Friday from 9 a.m. to 5p.m. EST. You can also email us at medicarebrokersupport@point32health.org.

HPHC Insurance Company Medicare Supplement

We are unable to process and activate new enrollment applications for HPHC Insurance Company Medicare Supplement plans in Maine, New Hampshire and Massachusetts until systems are back up and running. We are currently working on a solution to manually process new enrollees to the Medicare Supplement plans. If you submitted an application for a client with a May 1 effective date or later, we will update you once we know more.

If you have questions, call Medicare Broker Support at (833) 984-2387, Monday through Friday from 9 a.m. to 5 p.m. EST. You can also email us at medicarebrokersupport@point32health.org.

Contact Medicare Broker Support at (833) 984-2387, Monday through Friday from 9 a.m.to 5 p.m. EST. You can also email us at medicarebrokersupport@point32health.org.

Members should continue to call the Member Services number on the back of their ID cards for assistance. If they do not have their ID card available,

• Harvard Pilgrim Health Care Medicare Advantage Stride^SM(HMO)/(HMO-POS) members should call 888-609-0692 (TTY: 711)
• Harvard Pilgrim Health Care Medicare Supplement members should call 877-907-4742 (TTY: 711)
• Harvard Pilgrim Medicare Enhance members should call 888-333-4742 (TTY: 711)

No, members’ coverage will not be terminated during this time.

Harvard Pilgrim Health Care Stride^SM members were mailed a letter about the outage on May 2, 2023. We continue to update the member FAQ with questions and answers for them.

We have not sent any communications to HPHC Insurance Company Medicare Supplement members.

Yes, we have developed an FAQ for members. We have also set up a resources page where they can access plan documents, search for providers and look up covered drugs until our website and member portal are available.