Editor’s note: This article was published in our May 1 newsletter. Since publication, additional systems have been restored and we are now accepting claims for all lines of business. For up-to-date information, please refer to the System Update for Providers FAQ.
As you may know, on April 17, Point32Health identified a cybersecurity ransomware incident that impacted systems we use to service members, accounts, brokers, and providers.
The incident is impacting systems that support Harvard Pilgrim Health Care’s commercial and StrideSM (HMO)/(HMO-POS) Medicare Advantage plans. (Tufts Health Plan, Tufts Medicare Preferred, Tufts Health Public Plans, and CarePartners of Connecticut plans are not impacted.)
After detecting the unauthorized party, we proactively took our Harvard Pilgrim Health Care systems offline to contain the threat. We have notified law enforcement and regulators and are working with third-party cybersecurity experts to conduct a thorough investigation into this incident and remediate the situation.
Abbreviated May provider newsletter issue
As a result of downstream complications stemming from this temporary system outage, we’re publishing an abbreviated version of this month’s issue of Insights and Updates for Providers. The issue is not as comprehensive as those you are accustomed to seeing and focuses instead on a cultivated selection of particularly notable updates. It’s important to Point32Health to keep our provider network informed and supported; as soon as we’ve restored the impacted systems, we intend to resume our usual process of producing more robust monthly provider newsletters.
You and your office staff can reference our System Update for Providers page for more information about the incident and its effects on Harvard Pilgrim Health Care plans.
There you’ll also find the answers to some frequently asked questions we’ve developed in an effort to minimize the negative impact of the system outage on our provider network and to aid in business continuity to the highest degree possible.
Topics covered include impact on utilization management and prior authorization processes, member eligibility status capabilities, reimbursement for services rendered, and more.
A few key things to keep in mind include:
- We are unable to accept claim submissions for Harvard Pilgrim Commercial members, and request that providers please hold these submissions until further notice. However, you should continue to submit claims for: Harvard Pilgrim Medicare Advantage StrideSM (HMO)/(HMO-POS) members and all Tufts Health Plan members, including Tufts Health Commercial Plans, Tufts Health Plan Senior Products, and Tufts Health Public Plans.
- It’s important to continue to care for members. Even if you are not able to ascertain copay amounts or confirm eligibility, it’s important to continue to ensure that patients can obtain health care. Once we resume providing eligibility files, you can then bill the member for the applicable copay. If it is determined, after having received care, that the member was not eligible on the date of service, Point32Health will nonetheless reimburse providers for the services.
- Effective April 15, 2023, and until further notice, Harvard Pilgrim Health Care commercial and Medicare Advantage StrideSM (HMO)/(HMO-POS) plans are waiving utilization management (UM) requirements, including prior authorization and notification, for medical and behavioral health covered services, except for the following: CAR-T Cell Therapy, gender-affirming surgical procedures, and solid organ transplant surgeries. We will not require providers to subsequently submit an authorization for services rendered while authorization is waived (from April 15, 2023 through the date at which our systems are operational).
- We will extend timely filing limits for claims affected by the system outage.
- Providers did not receive payment on April 21 and April 28 for services rendered to Harvard Pilgrim Health Care commercial members due to the cybersecurity ransomware incident. Please keep in mind that many lines of business were unaffected by this issue — including Harvard Pilgrim Health Care Medicare Advantage Stride℠ (HMO)/(HMO-POS), all Tufts Health Plan products, and CarePartners of Connecticut — and as such, provider payments were made on time and will continue without interruption. Until normal processes are restored, we will publish specific information about the status of provider payments for that week on Wednesday at noon on our FAQ page.
We recognize that this is a frustrating situation and appreciate your patience and understanding as we continue to work diligently to restore affected systems as quickly and as safely as possible.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Jesse Salvato, Stephen Wong,