We announced some modifications in how to reach us for certain transactions in recent issues of the newsletters and want to share this again to ensure you and your office staff have the information you need to work with us efficiently.
In addition, we are announcing a new fax number for referrals for Harvard Pilgrim Health Care Commercial members. Please keep the following in mind:
- Authorization, notification, and referral submission for medical services — Please be aware that we will discontinue accepting requests for authorization, notifications, and referrals by phone for Harvard Pilgrim Health Care Commercial members, effective for dates of services beginning Nov. 1, 2024 for medical services. Following this date, these requests should be submitted via fax or our secure provider portal, HPHConnect.
- Authorization, notification, and referral submission for behavioral health services — Effective Jan. 1, 2025, we will only accept behavioral health notifications and authorizations by phone for certain service types for Harvard Pilgrim Commercial members. Our Provider Services team will also be able guide you accordingly when you call.
- Fax number for Harvard Pilgrim referrals (NEW item) — As of Nov. 1, 2024, please begin utilizing the following fax number when submitting referrals by fax for Harvard Pilgrim members: 617-509-4297. You can also submit referrals via the secure portal HPHConnect or through NEHEN. For more information, please refer to Referral Policy and Procedures in the Harvard Pilgrim Commercial Provider Manual.
- Provider Service Center email discontinued — We are discontinuing use of the Provider Service Center email, [email protected], for all lines of business as of Oct. 1, 2024. On our Harvard Pilgrim secure provider portal, HPHConnect, you’ll still have the option of reaching the Provider Service Center directly via our Message Center.
Utilizing our secure portals
We encourage the use of our secure portals for a variety of transactions. You can submit specialty referrals and request authorizations securely, quickly, and easily using our secure portals — and authorization requests may be approved more quickly, often on the spot.
We are also introducing enhancements to the registration process for HPHConnect — aimed at streamlining the registration process and shortening registration turnaround times.
If you are not currently registered for HPHConnect, you can get started by completing this online enrollment form and following these registration instructions. To register for the Tufts Health Plan secure portal, follow these registration instructions.
Resources to guide you
If you are new to our secure portals, we have a variety of resources available to assist you with conducting these transactions, including:
- Secure portal user guides — Our HPHConnect user guides walk you step-by-step through conducting common transactions on the Harvard Pilgrim secure portal. Topics include submitting referral, authorization and notification entries for a variety of specific services, performing referral/authorization searches, checking the status of a referral/authorization transaction, and more. Visit the Provider Training guides page to view these resources, as well as Tufts Health Plan secure portal user guides.
- Quick videos — If you need assistance getting started with HPHConnect, we offer a variety of quick videos on topics such as registering for HPHConnect and checking referral or authorization status in HPHConnect.
- Harvard Pilgrim Commercial Provider Manual — The Referral, Notification and Authorization section of our Harvard Pilgrim Commercial Provider Manual offers the most-up-to date information on policies and procedures.
Medical Necessity Guidelines — Our Medical Necessity Guidelines detail coverage criteria and note the applicable fax number to use when requesting authorization for our lines of business.
Editor’s Note, Oct. 24, 2024: For clarification, providers may inquire about existing notification, prior authorizations and referrals by phone. In addition, if portal and fax are not available, Maine providers may utilize the Provider Service phone number for submission of notification, authorization, and referrals.