In preparation for the launch of our integrated and insourced behavioral health program on Nov. 1, 2023, we are sharing several tools and resources with you. Please share with your practice staff as needed.
As a reminder, this change impacts Harvard Pilgrim Health Care commercial members only — as they transition from using Optum/United Behavioral Health services to this new insourced model. Please continue to ask our health plan members to present their current member ID card to ensure accurate billing and claims processing for your services.
We created a handy Behavioral Health Quick Reference Guide to aid you with common transactions with Harvard Pilgrim, such as submitting claims, utilizing HPHConnect, checking eligibility, accessing refund reports and submitting a refund, viewing policies, and more. We encourage you to view and save it.
Getting Started
In addition, the following tips and resources are available to support you in working with us to provide outstanding behavioral health care to our commercial members.
- Training sessions — On Monday, Oct. 2 and Monday Nov. 13 from 11:30 a.m. –1 p.m., providers are invited to join us at our Canton headquarters for Preparing for Behavioral Health Insourcing, an introduction to Point32Health’s integrated behavioral health program. If you prefer to meet virtually, we offer a variety of virtual interactive sessions as well as recordings of trainings. Providers are encouraged to sign up today!
- HPHConnect — Harvard Pilgrim’s secure portal, HPHConnect enables providers to verify patient eligibility; send authorization and specialty referral requests and receive timely responses; and submit and track claims for commercial members. In addition, you can access a variety of reports, including negative balance and refund reports. Our HPHConnect user guides offer step-by-step instructions on completing transactions. To register for HPHConnect, follow these steps:
- Prior to Nov. 1, 2023: Behavioral health providers can get early access by registering now. Please complete both the online registration form and the Trading Partner Agreement. When completing the online registration, select option 2 (non-contracted provider), as your contract effective date is Nov. 1 or later.
- On or after Nov. 1, 2023: Complete the online registration form and select option 1 (you are currently contracted). You do not need to complete the Trading Partner Agreement.
- Electronic Funds Transfer (EFT) — Through our partnership with Payspan, you can receive deposit payments electronically to a bank account, receive electronic 835 ERAs and EOPs directly, and review current or past payments online. Here are some important EFT tips:
- When registering, include your accurate NPI. Leaving the NPI field blank or inputting an incorrect number during registration may interfere with your clearinghouse’s ability to process your ERA/835. If you leave the NPI field blank, your NPI will later appear as “9999999999.”
- If you are currently utilizing Payspan, please enable the auto registration process. If you have this setting enabled in Payspan, it will allow automatic enrollment for EFT once you begin receiving reimbursement from Harvard Pilgrim, eliminating the need to enroll manually.
- Refer to this EFT Quick Reference Guide for more details.
- Insights and Updates for Providers — Stay up to date on the latest news, policy changes, and process updates! Published monthly on our Point32Health website, the provider newsletter can also be delivered straight to your inbox.
- Provider website — www.harvardpilgrim.org/provider is dedicated to supporting your practice with Provider Manuals, user guides, medical necessity guidelines, pharmacy information, a behavioral health section, payment policies, disease management information, product pages, and more.
Where to submit claims
Harvard Pilgrim contracted providers should begin billing Harvard Pilgrim for behavioral health services provided to commercial members as of Nov.1, 2023. If, however, a commercial member is admitted on an acute inpatient unit prior to the Nov. 1, 2023 insourcing date and stays hospitalized until or beyond Nov. 1, 2023, the provider will continue to work with Optum for utilization management and should bill Optum for payment of the full inpatient admission episode.
We encourage electronic submission of claims through EDI channels or HPHConnect for ease, speed, and efficiency.
Harvard Pilgrim’s electronic payer ID number: 04271
Paper claims mailing address:
Harvard Pilgrim Health Care
P.O. Box 699183
Quincy, MA 02269-9183.
Prior authorization requests
When insourcing occurs on Nov. 1, 2023, open authorizations obtained from Optum/UBH will be honored through their expiration date. For new prior authorization requests, we encourage use of HPHConnect. You may also fax authorization requests to 800-232-0816 or call the Provider Service Center at 800-708-4414.
Policies and forms
You’ll find the commercial policies and forms you need on our provider website, including:
- Commercial Provider Manual
- Forms
- 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
Contracting reminders
If you already signed a contract to provide care to Harvard Pilgrim commercial members, your contract with Harvard Pilgrim will apply to covered services you provide to our members on and after Nov. 1, 2023 (except for inpatient admissions that begin prior to Nov. 1, 2023, as described above). 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 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 [email protected] or by phone at 617-972-9400 x43145.
Additional information
Harvard Pilgrim Health Care Medicare Advantage StrideSM (HMO)/(HMO-POS) members are not impacted by this change and will continue to be serviced by Optum/UnitedBehavioral Health.
Audrey Kleinberg,
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