A cybersecurity ransomware incident has impacted systems that support Harvard Pilgrim’s Commercial and Stride Medicare Advantage plans. (Refer to our System Update for Providers page for more information.) Due to related complications, this month’s provider newsletter issue is abbreviated.
Insights and Updates for Providers
President Joe Biden has signed a bill that will officially end the federal COVID-19 Public Health Emergency at the end of the day on May 11, 2023. As a result, Point32Health is returning to many pre-pandemic operations and policies.
Effective July 1, 2023, Point32Health is updating our Commercial Group Insurance Commission product offerings, which will include the custom products Harvard Pilgrim Quality HMO and Harvard Pilgrim Explorer POS.
For dates of service beginning July 1, all claims for both medical and behavioral health services, including those performed at community mental health centers, will be subject to claims edits and processed consistently across our claims platforms for the legacy brands.
Point32Health is collaborating with Freespira, Inc. to offer a new, evidence-based pilot program, which is now available for eligible fully insured Commercial Harvard Pilgrim Health Care members ages 18 and over in Massachusetts, New Hampshire, and Maine.
As a result of the FDA’s decision on April 6 to withdraw approval of Makena — both the brand name and generic injection — Point32Health will not authorize any prior authorization requests for new starts for Commercial, Tufts Health Direct, and Tufts Health RITogether members.
Effective for dates of service beginning July 1, 2023, the medications identified in this article will no longer be offered through CVS Caremark as part of Tufts Health Plan’s office-administered medical drug/white bagging program.
Effective for dates of service beginning July 1, 2023, Point32Health will no longer provide reimbursement for claims submitted with modifiers TM and TR for services provided in conjunction with a student’s individualized education program.
We’re updating our Medical Necessity Guidelines for the behavioral health services Transcranial Magnetic Stimulation, Psychological Testing and Assessment, and Neuropsychological Testing and Assessment, effective for dates of service beginning July 1, 2023.