The mailing address for all Harvard Pilgrim Stride claims submissions has changed. Going forward, please use the Eagan, MN address identified in this article, which has replaced all previous addresses in Lubbock, TX (P.O. Boxes 16755, 93430, and 6748).
Point32Health would like to remind any providers who are planning to offer concierge medicine services to eligible members that you are required to provide Point32Health at least 90 days’ advance notice prior to establishing a concierge-style practice.
Effective for fill dates on or after Jan. 1, 2024, the following coverage requirements will apply to the Part B Step Therapy program for Harvard Pilgrim Stride (HMO)/(HMO-POS) Medicare Advantage, Tufts Medicare Preferred, Senior Care Options, and Tufts Health Unify.
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.
We would like to provide some reminders regarding the steps a contracted provider must take prior to billing members of our Harvard Pilgrim Health Care and Tufts Health Plan Medicare Advantage plans/Senior Products for non-covered services.
In a continued effort to reduce prior authorization burden on providers and members, effective Sept. 1, 2023 these drugs will no longer require prior authorization through OncoHealth for oncology indications for members of Harvard Pilgrim’s commercial and Stride Medicare Advantage plans.
Integra will soon begin to assume management of the DMEPOS provider network for Point32Health’s Senior Products, starting on July 1, 2023 for Tufts Medicare Preferred and Tufts Health Plan Senior Care Options, and on Sept. 1, 2023 for Harvard Pilgrim Stride (HMO)(HMO-POS) Medicare Advantage.
In the April issue of Insights and Updates for Providers, Point32Health announced a number of changes expected to take effect June 1, 2023 in relation to the medical necessity review and prior authorization program that National Imaging Associates, Inc. (NIA) oversees on our behalf for certain procedures.
Harvard Pilgrim is no longer using OncoHealth for radiation oncology medical management for Commercial and Stride members. In an effort to more closely align the provider experience across Point32Health products, we’re also implementing some changes for Tufts Health Plan products.
This chart identifies code updates to Point32Health and National Imaging Associates, Inc.’s (NIA’s) medical necessity review program, which are effective June 1, 2023 and intended to align coverage and criteria for the Harvard Pilgrim and Tufts Health Plan products included in the program.
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 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.