As you know, it’s important for our provider partners to check members’ benefits and eligibility prior to initiating care or referring them for a service to ensure that they have active health insurance coverage through a Harvard Pilgrim or Tufts Health Plan product and that the service is covered under their plan.
We’re offering some reminders and a few additional resources to help with this process. To help determine if a member is eligible (and for many other quick and convenient self-service capabilities), we recommend using our secure provider portals. You can find more guidance on how to verify a member’s benefits and eligibility in the following reference guides:
- Harvard Pilgrim Health Care Member Eligibility Verification User Guide
- Tufts Health Plan Eligibility and Benefits Inquiry Quick Reference Guide
Remember to always make sure a member is covered for a service before referring or billing. Billing a member for a service that is not covered under their plan is generally not allowed and will not be reimbursed, unless the member provides an advance written agreement to pay for the specific non-covered service.
For more details on determining eligibility, collecting member payment, and more, you can refer to the Provider Manual corresponding to the member’s plan.