We’re sharing a plan update for the Painters & Allied Trades District Council No. 35 union. Previously, coverage for the union was provided via a shared administrative account in which both Point32Health and the union managed plan responsibilities. However, as of July 1, 2025, this will become a standard self-funded account. As a result, please keep the following in mind:
- Union members will continue to participate in the Harvard Pilgrim Commercial plan.
- Harvard Pilgrim will be responsible for claims adjudication and sending Explanations of Payment (EOPs). There is no change in claims submission. You can continue to submit claims electronically via our secure HPHConnect Provider portal, EDI submission, or paper (Harvard Pilgrim Health Care, P.O. Box 699183, Quincy, MA 02269-9183).
- Member ID cards were replaced in early June and will display the standard HP prefix with alphanumeric member ID (rather than the previous customized 9-character union member ID prefixed with A).
- You can check member eligibility via HPHConnect, through NEHEN (the New England Healthcare EDI Network) or by calling the Provider Service Center, rather than calling the Painter’s union.
- Our standard Commercial Medical Necessity Guidelines will now apply for this plan. For details on services requiring prior authorization, consult the Medical Necessity Guidelines and the Harvard Pilgrim Commercial Referral/Authorization Quick Reference Guide.
- You should submit notification and prior authorization requests as you normally would for a Harvard Pilgrim standard account.
Refer to the Point32Health provider website for additional information and resources, including pharmacy policies and our Harvard Pilgrim Health Care Commercial Provider Manual.