Harvard Pilgrim is making an update to the electronic prior authorization request submission process in HPHConnect, effective May 4, 2023. As a result, Contact Name and Contact Info will become required fields when submitting an outpatient service transaction.
We would like to provide some clarity regarding the correct processes for initiating prior authorization requests for assisted reproductive technology services for members of Harvard Pilgrim Health Care Commercial products, Tufts Health Plan Commercial products, and Tufts Health Direct.
Effective for dates of service beginning May 1, 2023, Harvard Pilgrim Health Care’s Commercial plans will no longer provide reimbursement for hydration therapy (CPT codes 96360, 96361, J7030, J7040, J7042, J7050, J7060, J7070, J7120, or J7121) when billed without a requisite diagnosis on the claim for members older than 18 years of age.
Harvard Pilgrim Health Care and OncoHealth are implementing a step therapy/preferred product strategy for a number of drug classes, effective for dates of service beginning April 1, 2023 for Harvard Pilgrim Commercial members.
As of April 1, 2023, Harvard Pilgrim’s Commercial and Stride (HMO)/(HMO-POS) Medicare Advantage plans will no longer use OncoHealth for radiation oncology medical management.
Beginning April 1, 2023 for Harvard Pilgrim members, oral enteral formulas must be obtained through a contracted durable medical equipment provider, rather than at a retail pharmacy in order for them to be covered.
Beginning March 1, 2023, AIM Specialty Health (Harvard Pilgrim and Tufts Health Public Plans’ genetic/genomic and molecular diagnostic testing services utilization management vendor) will be known by a new name: Carelon Medical Benefits Management.