Harvard Pilgrim is making an update to the electronic prior authorization request submission process in HPHConnect, our online provider portal, which will take effect May 4, 2023.
With the update, Contact Name and Contact Info will become required fields when submitting an outpatient service transaction. Today, these fields are required for inpatient services, but optional for outpatient services.
We anticipate that this change will reduce administrative turnaround time by cutting down on the time required for Harvard Pilgrim to gather information for authorization review while claims are in pend status.
When submitting an electronic outpatient authorization request today, after selecting “Outpatient” from the New Request drop down list, you would be prompted to complete the required fields indicated with a red asterisk (e.g., patient name, diagnosis code, requesting provider, servicing provider) as well as the optional fields, including Contact Name and Contact Info, before clicking “Submit.” As of May 4, Contact Name and Contact Info will be indicated with a red asterisk and included as required fields.
Our DME, Habilitative and Rehabilitative Therapies, and Surgical Day Care User Guides will be updated in advance of the May 4 effective date to reflect this change in the outpatient prior authorization request process.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Jesse Salvato, Stephen Wong