Use code A4287 for coverage of breast milk storage bags
Use code A4287, not K1005, for coverage of breast milk storage bags.
Insights and Updates for Providers
October 2024
Clarification: Prior authorization on insulin infusion pumps
Authorization required for insulin pumps which work in conjunction with a CGM device.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
2024 Physician Group Honor Roll announced
53 physician groups named to Harvard Pilgrim’s Physician Group Honor Roll.
Behavioral Health hub for members
New resource for Harvard Pilgrim members regarding behavioral health topics.
Important tips to minimize denials
Tips for a smooth Harvard Pilgrim commercial migration process and accurate claims reimbursement.
Ovia Health’s Family & Maternal Health Solutions
Ovia Health now available to Tufts Health Together and Tufts Health RITogether members.
Maine mandate and new coverage for donor breast milk
Beginning Jan. 1, donor breast milk will be covered for eligible infants in Maine.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
Connecticut market exit reminder
Reminder about Harvard Pilgrim Health Care’s withdrawal of fully insured commercial products in Connecticut as of Jan. 1, 2024.
Crisis resource reminder for Massachusetts members
Learn more about Community Behavioral Health Center resources available in Massachusetts.
Maine mandates and new coverage
Commercial medical necessity guideline updates to align with recent legislation in Maine.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
Reminder and clarification of billing requirements for Spravato
Reminder and clarification on billing for Spravato nasal spray.
Urine Drug Testing Payment Policy integration
Urine Drug Testing coverage and payment policy updates.
Updates on Rhode Island for 2024
Read about our 2024 commercial migration, new product, and more!
New ICD-10 code for HIV PrEP
HIV PrEP billing requirements and new ICD-10 code.
Pharmacy coverage changes
Jan. 1, 2024 Pharmacy coverage changes for various Point32Health products.
Preferred oncology biosimilars for 2024
Preferred products for the bevacizumab, rituximab, and trastuzumab drug classes.
Other 2024 Pharmacy program updates
2024 Pharmacy updates: Harvard Pilgrim commercial, Tufts commercial, Tufts Health Direct.
Point32Health PPACA coverage alignment
Jan. 1 coding/coverage updates to Harvard Pilgrim PPACA policy.
Complex Care Management services
Point32Health provides care management services for adult and pediatric members.
About Our Chronic Condition Management Programs
Point32Health’s approach to chronic condition management through patient-centered care.