We’re pleased to be moving ahead with behavioral health insourcing effective Nov. 1, 2023 and have a number of resources to ensure behavioral health providers have all the information they need to begin caring for Harvard Pilgrim commercial members.
Insights and Updates for Providers
We want to ensure that our Medicaid members are aware that they must take action to have their eligibility redetermined and renew their coverage — and you and your practice play an important role in assisting with these efforts.
After the resounding success of the July claims consultation event we hosted at our Canton, MA headquarters, Point32Health is delighted to share that we’re expanding the series beyond Massachusetts and offering events in other states.
For 2024, Point32Health will not be refreshing tier assignments for the Harvard Pilgrim’s ChoiceNet HMO and PPO plans; all provider tier classifications will remain consistent with classifications for the 2023 plan year.
To avoid denials based on missing information needed for Point32Health to conduct a complete prior authorization review, and to avoid delays in patient care, please respond back timely to requests for more information.
When billing for HIV PrEP and other related services, please bill in accordance with our Harvard Pilgrim Patient Protection and Affordable Care Act (Federal Health Care Reform) policy and Tufts Health Plan Preventive Services Payment Policy.
While MassHealth is working to renew member eligibility, there may be several eligibility updates occurring at this time. In MassHealth All Provider Bulletin 372, MassHealth shared important reminders of billing responsibilities and billing for retroactively reinstated members.
The flu season runs from October through April each year, and given the ongoing COVID pandemic, it’s particularly important to emphasize the importance of getting the 2023-2024 flu vaccine to your patients.
Reducing hospital readmissions within 30 days is a considerable priority in health care, leading to increased patient satisfaction and improved outcomes.
Patients taking antipsychotic medications are at increased risk of developing health conditions including diabetes, high blood pressure, abnormal cholesterol and triglyceride levels, and obesity. Yearly screening and regular metabolic monitoring is vital for children, adolescents, and adults on these medications.
As a follow-up to our July 2023 communication regarding the Initiation and Engagement of Substance Use Disorder Treatment (IET) HEDIS measure, which assesses the follow-up care patients receive after a new episode of substance use disorder (SUD), we’d like to offer some additional tips to keep in mind.
Providers and office staff can refer to the following chart to review changes and updates to Point32Health’s Medical Necessity Guidelines (MNGs), information about newly developed MNGs, and more.
Effective for dates of service beginning Nov. 1, 2023, Point32Health will require that providers billing for Spravato (esketamine) nasal spray for Harvard Pilgrim commercial members include HCPCS code G2082 or G2083 on the medical claim, in addition to HCPCS code S0013, which will also continue to be required.
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
As a reminder, Harvard Pilgrim commercial members who are currently taking a long-acting opioid and who have not had a clinical review completed will require authorization on or after Nov. 1, 2023.
We’ve developed a payment policy illustrating reimbursement, reporting, and billing policies and requirements for services related to serious reportable events and provider preventable conditions for our Harvard Pilgrim Health Care Stride (HMO)/(HMO-POS) Medicare Advantage products.