We’re here to support our provider network — including behavioral health providers who are newly contracted to see Harvard Pilgrim Health Care commercial members, effective Nov. 1, 2023. We’re pleased to be moving ahead with behavioral health insourcing and have a number of resources to ensure behavioral health providers have all the information they need to begin caring for Harvard Pilgrim commercial members.
- In-person training events — We’re offering events at our Canton headquarters on Preparing for Behavioral Health Insourcing. The session will guide behavioral health providers through our behavioral health model, accessing resources, and using our secure portal HPHConnect for common transactions. It will also include an opportunity to ask questions. We’re offering events from 11:30 a.m.–1 p.m. on Monday, Sept. 18; Monday, Oct. 2; and Monday, Nov. 13. Refreshments will be served. Registration is required; you can register by emailing email@example.com. For more information on behavioral health trainings, please refer to the Training section of our provider website.
- Virtual training events — Can’t attend a live session? We invite you to attend one of our virtual behavioral health insourcing updates sessions. Sign up today!
Getting off to a smooth start
- Register for HPHConnect — Harvard Pilgrim’s secure portal, HPHConnect, supports a full range of transactions, such as verifying patient eligibility; sending authorization and specialty referral requests and receiving a timely response; and submitting and tracking claims. Registration instructions are found in the HPHConnect section of our provider website. If you need assistance call 800-708-4414 (option 1, then press 6), or email Provider_eBusiness_ Services@point32health.org.
- Sign up for the Provider Newsletter — You can view this monthly provider newsletter on our Point32Health provider website or register to have a copy delivered straight to your inbox.
- Enroll in EFT — Electronic payment is fast, secure, and easy. Through our partnership with Payspan, you can deposit your payments electronically to a bank account, receive electronic 835 ERAs and EOPs directly, and review current or past payments. Visit the Electronic Payment section of our website for more information.
- Check out our website — begin at www.harvardpilgrim.org/provider to access a wealth of resources to support your practice, including Provider Manuals, user guides, medical necessity guidelines, pharmacy information, a behavioral health section, payment policies, disease management information, product pages, and more. We also encourage you to visit www.point32health.org/provider, where you can find additional resources.
For dates of service beginning Nov. 1st, Harvard Pilgrim contracted providers should bill Harvard Pilgrim directly for behavioral health services for commercial members, rather than billing Optum/UBH. (Please note: If a commercial member is admitted prior to the Nov 1st insourcing and stays until or beyond Nov 1st, the provider will continue to work with Optum for utilization management and should bill Optum directly for payment of the full admission episode.)
We encourage electronic submission of claims through EDI channels or HPHConnect for the greatest speed and efficiency. Harvard Pilgrim’s electronic payer ID number is 04271. If you opt to submit paper claims, you can send them to Harvard Pilgrim Health Care, P.O. Box 699183, Quincy, MA 02269-9183.
You’ll find more information in the Billing and Reimbursement section of our Provider Manual, including information on claims submission, replacement claim billing, standard filing limits and more.
Requesting prior authorization
When insourcing occurs on Nov. 1, 2023, open authorizations obtained from Optum/UBH will be honored through their expiration date. To request a new prior authorization, we encourage use of HPHConnect. Our handy user guides and reference materials offer step-by-step instructions to help you with e-transactions. You may also request authorization by FAX (800-232-0816) or by calling the Referral/Authorization unit of our Provider Service Center (800-708-4414).
Policies and forms
We are updating our forms and policies in anticipation of behavioral health insourcing. Many items are already posted for the Nov. 1, 2023 effective date, and we will continue to post materials in the coming weeks. We encourage you to refer to the following policies and materials applicable for commercial members:
- Medical Necessity Guidelines and Medical Benefit Drug Medical Necessity Guidelines
- Payment policies (including the Behavioral Health and Substance Use Disorder Payment Policy and the Autism Professional Payment Policy)
- Pharmacy resources
- Commercial Provider Manual
We are committed to offering a robust behavioral health network. If you already signed a contract to provide care for Harvard Pilgrim commercial members, the effective date of your contract is Nov. 1, 2023. Point32Health fee schedules were recently mailed to contracted behavioral health providers; if you did not receive one or have questions, please contact AHCBehavioralHealth@point32health.org.
If you are a behavioral health provider and received a contracting packet or a contract amendment from us, we encourage you to complete any remaining steps as soon as possible. If you have any questions about your contracting packet or you didn’t receive a packet and would like to be part of our Harvard Pilgrim behavioral health network, please contact us by email at AHCBehavioralHealth@point32health.org or by phone at 617-972-9400 x43145.
Harvard Pilgrim Health Care Medicare Advantage StrideSM (HMO)/(HMO-POS) will not be insourcing and will continue to be serviced by Optum Behavioral Health.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Susan Panos, Stephen Wong,