Insights and Updates for Providers - April 2024

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Updates to medical drug claims editing logic

We’re updating medical drug claims editing logic to remove certain edits.

Claims system upgrade for select Medicare products

We’re updating some Medicare claims systems — no provider action is required.

UM update for home health care services

We’re updating home health care UM requirements for quality and efficiency.

Electronic Tools and Resources

Our electronic transaction capabilities make doing business with us quick and efficient. Explore our electronic services and learn about our secure portal capabilities for:

  • PPO/POS Video Short

    Providers outside our service area can see any Harvard Pilgrim Health Care PPO/POS member for covered services. This quick video gives an overview for providers who are in our Harvard Pilgrim’s national network through UnitedHealthcare or out-of-network.

With the Point32Health Provider site, we aim to make it easy for you to work with us to support our members’ health and wellbeing — including providing you and your office staff with updated information for both our legacy brands, Harvard Pilgrim Health Care and Tufts Health Plan. While we still offer provider information on the sites of our legacy brands, over time you’ll see more provider information and resources move to these pages.