Back to Insights and Updates for ProvidersMarch 2023

Requests for assisted reproductive technology services

Harvard Pilgrim Health Care Commercial  |  Tufts Health Direct  |  Tufts Health Plan Commercial

As a reminder, Point32Health published the following new medical necessity guidelines (MNGs), effective Jan. 1, 2023, pertaining to assisted reproductive technology services for members of Harvard Pilgrim Health Care Commercial products, Tufts Health Plan Commercial products, and Tufts Health Direct:

These MNGs have been developed in addition to, not in replacement of, our respective legacy plans’ existing Infertility Services MNGs. Refer to the new MNGs for complete information, including full clinical coverage criteria for various services, codes requiring prior authorization, limitations, and appropriate contact information.

Requesting authorization and corrected fax numbers
You can request prior authorization for infertility/assisted reproductive technology services online via our Harvard Pilgrim and Tufts Health Plan provider portals — which we recommend for their ease of use and quick turnaround times — as well as by fax.

We recently updated our MNGs for assisted reproductive technology services to ensure that they now contain the correct fax numbers for authorization requests.

When initiating prior authorization requests by fax, please be sure to submit the required documentation via the applicable channel indicated below:

  • Harvard Pilgrim Referral and Authorization Unit: 800-232-0816
  • Tufts Health Plan Precertification Department:
    • 617-972-9409 for Commercial products
    • 888-415-9055 for Tufts Health Direct

In addition, we’d like to clarify that a separate authorization is not required for associated injectable pharmacy benefit drugs that are formulary once a request for an assisted reproductive technology service has been approved. (A separate authorization is required for non-formulary medications.)

Audrey Kleinberg
Director, Provider Relations & Communications

Annmarie Dadoly
Senior Manager, Provider Communications

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