Insights and Updates for Providers

March 2023

Requests for assisted reproductive technology services

Harvard Pilgrim Health Care Commercial  |  Tufts Health Direct  |  Tufts Health Plan Commercial

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.

Change to OncoHealth radiation program on April 1

Harvard Pilgrim Health Care Commercial  |  Harvard Pilgrim Stride (HMO) Medicare Advantage  |  Tufts Health Plan Commercial  |  Tufts Health Public Plans

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.

Obtaining oral formulas

Harvard Pilgrim Health Care Commercial  |  Tufts Health Direct  |  Tufts Health Plan Commercial

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.

Home infusion claims update

Tufts Health Plan Commercial  |  Tufts Health Plan SCO  |  Tufts Medicare Preferred

Effective for dates of service beginning April 1, 2023, Tufts Health Plan is insourcing claims pricing and processing for home infusion services for Tufts Health Plan Commercial, Tufts Medicare Preferred and Tufts Health Plan Senior Care Options.