Back to Insights and Updates for ProvidersMarch 2024

Oral formula authorization request update

Harvard Pilgrim Health Care Commercial  |  Harvard Pilgrim Stride (HMO) Medicare Advantage

In last month’s issue of Insights and Updates for Providers, Point32Health communicated that as of Feb. 22, 2024, contracted durable medical equipment (DME) providers submitting prior authorizations for oral enteral formula for Harvard Pilgrim Commercial and StrideSM (HMO)/(HMO-POS) Medicare Advantage members would be able to request the number of days for which they will provide formula.

We have encountered some system delays and will need to postpone this capability, and ask that DME providers please continue to request authorization for oral formula as you have done previously: by identifying the number of units of formula you intend to dispense over the course of the date span on the authorization. For the time being, the number of units of formula will continue to be used as the count qualifier on the authorization, as opposed to the number of days.

We apologize for any confusion this may have caused, and encourage you to refer to future issues of Insights and Updates for Providers for updates regarding the submission of formula authorization requests.

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Senior Manager, Provider Communications

Joseph O’Riordan, Susan Panos, Ellen Gustavson, Ryan Francis, Stephen Wong,

Kristin Edmonston,
Production Coordinator

Kristina Cicelova,
Graphic Designer