Reminder on home infusion administration
Authorization is not required for the administration of home infusion drugs; however, it is still required for the home infusion drugs themselves.
Insights and Updates for Providers
May 2025
Prior authorization required for noninvasive prenatal testing
Point32Health requires prior authorization for coverage of all prenatal testing, including NIPT, which can be requested using the resources provided here.
Behavioral health service navigation program for members
We recently launched our behavioral health service navigation program to provide personalized guidance for patients seeking information regarding telebehavioral health care.
Pharmacy coverage changes
We have made updates to our pharmacy program; please refer to the Pharmacy Medical Necessity Guidelines page on our website for more details.
Change Healthcare update: Timely filing limits and claim adjustment requirements to resume
Point32Health will return to our standard requirements for all lines of business regarding timely filing and claim adjustments, effective Sept. 1, 2024.
Recovering negative balances
We have outlined reasons why a claim may be retracted, resulting in a negative balance, and ways to resolve a negative balance.
ConnectorCare plans – in-network coverage reminder
Harvard Pilgrim has joined Tufts Health Plan as a ConnectorCare issuer for 2024, expanding access to affordable health care coverage for thousands of Massachusetts residents.
Reminder: removal of certain prior authorization requirements
We would like to remind our providers of certain procedures and associated codes that no longer require prior authorization.
Coverage reminder – Community Behavioral Health Center services
We would like to remind providers of notification requirements and billing procedures related to Community Behavioral Health Center services.
Pharmacy coverage changes
We have made updates to our pharmacy program; please refer to the Pharmacy Medical Necessity Guidelines page on our website for more details.
Removal of prior authorization requirements for certain procedures
We are removing prior authorization requirements from certain procedures and associated codes in a continued effort to administratively simplify providers’ experience.
2024 Home Care Seasonal Flu Vaccine Fee Schedule
Updates to Harvard Pilgrim’s standard home care seasonal influenza vaccine fee schedule will take effect on Aug. 1, 2024
Good Measures Healthy Weight program launches for members
Harvard Pilgrim Health Care has partnered with Good Measures to offer their Healthy Weight program to members with certain weight/nutrition-related conditions.
Pharmacy coverage changes
Read about updates to Point32Health’s Pharmacy program and our Pharmacy Medical Necessity Guidelines for Harvard Pilgrim and Tufts Health Plan.