Back to Insights and Updates for ProvidersJune 2023

System updates for our provider network

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Editor’s note: This article was published in our June 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.

We continue our work in restoring our core Harvard Pilgrim Health Care systems and encourage providers and office staff to visit our System Update for Providers FAQ for the latest information. We will also continue to send emails to our newsletter subscribers and HPHConnect users with important updates.

About the cybersecurity incident

On April 17, Point32Health identified a cybersecurity ransomware incident that impacted systems we use to service members, accounts, brokers and providers. This is impacting systems that support Harvard Pilgrim Health Care commercial and Medicare Advantage StrideSM plans (HMO)/(HMO-POS). Tufts Health Plan, Tufts Medicare Preferred, Tufts Health Public Plans and CarePartners of Connecticut systems remain accessible.

After detecting the unauthorized party, we proactively took our Harvard Pilgrim Health Care systems offline to contain the threat. While we work diligently to restore affected systems as quickly and as safely as possible, our team is working around the clock so that Harvard Pilgrim Health Care (HPHC) members receive the services they need.

Recent updates

The online System Update for Providers FAQ includes information on recent updates including:

  • Eligibility information — We have restored capabilities for 270/271 eligibility transactions for Harvard Pilgrim Health Care commercial plans. You can now check eligibility for Harvard Pilgrim Health Care commercial members who were enrolled on or before April 15, 2023 via HPHConnect, the Provider Call Center, batch 270/271 transactions, and trading partners.
    • The information reflects member participation in a Harvard Pilgrim commercial plan through April 15. Please be aware that eligibility information for members who enrolled with Harvard Pilgrim Health Care commercial plans on or after April 16 is not currently available. We have issued temporary member ID cards (starting with P3 rather than the standard HP) and/or eligibility letters to new members; please accept the temporary ID card/or eligibility letters are proof of eligibility and provide care to these members.
    • For Medicare Advantage StrideSM (HMO)/(HMO-POS) members, providers can continue to access eligibility information through the Stride provider portal.
  • Claims processing — We understand the impact on payment delays for providers and identified claims processing and provider reimbursement as a top priority as we work to bring systems back online. We recently were able to process and release payment for additional claims that were already in process when we shut our systems down on April 17. We are continuing to work to restore our full claims processing and payment capabilities and will keep you updated on progress.
    • Meanwhile, please continue to hold claims submissions for Harvard Pilgrim Health Care commercial members until further notice.
    • You should continue to submit claims for members of Harvard Pilgrim Medicare Advantage StrideSM (HMO)/(HMO-POS) and Tufts Health Plan (including commercial, Tufts Health Plan Senior Products, and Tufts Health Public Plans).
  • Behavioral health services for Harvard Pilgrim commercial members — Due to the continuous work on restoration efforts, we have pushed back insourcing our Behavioral Health program for Harvard Pilgrim commercial members to fall 2023, instead of the originally scheduled date of July 1. By delaying the implementation, we can ensure the continuity of care for our members, while our staff continues work on the current outage.
    • There is no impact to Harvard Pilgrim Health Care Medicare Advantage StrideSM (HMO)/(HMO-POS) or Tufts Health Plan members.
    • Although our rollout is delayed, there will be no interruption to care or provider access for our Harvard Pilgrim Health Care members. All Harvard Pilgrim Health Care members in New England and nationwide will be able to continue to see their providers as they do today based on their current health plan designs.
    • Until insourcing occurs, Optum/UBH will continue to provide behavioral health services for Harvard Pilgrim members. Providers should continue to send behavioral health claims for Harvard Pilgrim members to Optum/UBH as you do today.
    • We are continuing to grow our behavioral health network. If you are a behavioral health provider who received a contracting packet from us, we encourage you to complete any necessary steps as soon as possible. This will help us offer a robust behavioral health network for our members and uninterrupted care to Harvard Pilgrim commercial members when insourcing occurs.

We appreciate your partnership in ensuring our members receive high-quality health care services, and your understanding during this challenging time.

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Senior Manager, Provider Communications

Joseph O’Riordan, Jesse Salvato, Stephen Wong,

Kristin Edmonston,
Production Coordinator

Kristina Cicelova,
Graphic Designer