Vendor programs

Prior authorization programs with vendors

VendorProductsServicesDetails and contact info
Carelon Medical Benefits Management
(formerly AIM Specialty Health)
Harvard Pilgrim Health Care Commercial, Harvard Pilgrim Health Care Stride (HMO/HMO-POS) Medicare Advantage, Tufts Health Direct, Tufts Health Plan Together, Tufts Health Plan RITogether, Tufts Health One CareGenetic and Molecular Diagnostic TestingView details
EviCoreTufts Health Plan Commercial, Tufts Health Direct, Tufts Health Plan Together, Tufts Health Medicare Preferred
(for Harvard Pilgrim members, refer to Evolent below)
  • Sleep studies
  • PAP supplies
View details
Evolent
(formerly National Imaging Associates/NIA)
Harvard Pilgrim Health Care Commercial, Harvard Pilgrim Health Care Stride (HMO/HMO-POS) Medicare Advantage, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Plan Together, Tufts Health Plan RITogether, Tufts Health One Care
  • Cardiac Diagnostic Tests/Interventional Procedures
  • High-tech diagnostic Imaging Services
  • Select Joint Surgeries (Hip/Knee/Shoulder)
  • Sleep Studies for Harvard Pilgrim Health Care members only (for Tufts Health Plan members, refer to eviCore above)
  • Spine Services (Lumbar Spine Surgery, Interventional Spine Pain Management Services, and Cervical Spine Surgery)
View details
OncoHealth 
(formerly Oncology Analytics)
Harvard Pilgrim Health Care Commercial, Harvard Pilgrim Health Care Stride (HMO/HMO-POS) Medicare AdvantageOutpatient chemotherapy (infused and/or injected)View details
Optum/United Behavioral HealthHarvard Pilgrim Health Care Stride (HMO/HMO-POS) Medicare AdvantageBehavioral Health for Stride (HMO)/(HMO-POS) Medicare AdvantageView details
Progeny HealthHarvard Pilgrim Health Care CommercialNon-routine newborn care (Level II-IV) and all neonatal intensive care unit (NICU) admissionsView details