We want to provide you with an update on our plans to insource our behavioral health program for Harvard Pilgrim commercial members.
In June, we notified providers that we moved back our planned insourcing of behavioral health to allow us to focus on system restoration following the cybersecurity incident. Now that our systems are online and we are returning to business as usual, we will insource our behavioral health program for Harvard Pilgrim commercial members effective Nov. 1, 2023.
Harvard Pilgrim Health Care Medicare Advantage StrideSM (HMO)/(HMO-POS) will not be insourcing and will continue to be serviced by Optum Behavioral Health.
Starting Nov 1st, Harvard Pilgrim contracted providers should bill Harvard Pilgrim directly for behavioral health services for commercial members, rather than billing Optum/UBH. (Please note: If a commercial member is admitted at the time of insourcing, spanning prior to and beyond Nov 1st, the provider will continue to work with Optum for utilization management and should bill Optum directly for payment of the full admission episode.)
While additional information will be shared in the upcoming weeks, please keep the following in mind related to behavioral health insourcing:
- Expanding our network — We are committed to expanding our behavioral health network. 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 any 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 AHCBehavioralHealth@point32health.org or by phone at 617-972-9400 x43145.
- Contract effective date — If you already signed a contract to provide care for Harvard Pilgrim commercial members, the effective date of your contract is Nov. 1, 2023. Point32Health fee schedules were recently mailed to contracted behavioral health providers; if you did not receive one or have questions, please contact AHCBehavioralHealth@point32health.org.
- Commercial migration & behavioral health — We continue to move commercial Tufts Health Plan members to Harvard Pilgrim plans upon their account renewal date (for more, see our Integration FAQ for providers).
- If your patient’s insurance change occurs before Nov. 1 and you participate in Optum/UBH: Follow Optum/UBH behavioral health policies and bill Optum/UBH for services.
- If your patient’s insurance change occurs before Nov. 1 and you don’t participate in Optum/UBH: Please contact Optum/UBH to receive a single case agreement at 888-777-4742. If you already have a single case agreement in place with Optum, but it was slated to end as of June 30, 2023 it has been updated to be valid through Oct. 31, 2023.
- If your patient’s insurance change occurs after Nov. 1: Bill Harvard Pilgrim directly. Members will utilize the Harvard Pilgrim behavioral health network, and Harvard Pilgrim/Point32Health policies, fee schedules, and processes apply.
- Open authorizations — When insourcing occurs on Nov. 1, 2023, open authorizations obtained from Optum/UBH will be honored through their expiration date.
- Behavioral health payment policy — The Point32Health Behavioral Health and Substance Use Disorder Payment Policy currently applies for Tufts Health Plan, but will apply for Harvard Pilgrim commercial plans as of Nov. 1, 2023.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Susan Panos, Stephen Wong,