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Back to Harvard Pilgrim Health Care Commercial Provider Manual

Network Operations & Care Delivery Management

Harvard Pilgrim Health Care Commercial Provider Manual

Provider Network
  • Provider Communications
  • Directory Accuracy and Suppression of Unverified Provider Information
  • Provider Inactivity and Administrative Termination of Network Providers
  • Primary Care Providers
  • Specialists
  • Local Care Units (LCUs)
  • Facility Care Services
  • Selected Provider Networks
  • Clinician Credentialing and Recredentialing
  • Facility Credentialing and Recredentialing
  • Practice Site Standards
  • Limited Service Provider – Retail Medicine
  • Urgent Care & Walk-In Providers
  • Tiered Provider Network Review Guidelines
    Provider Network: Performance Standards & Expectations
    • Home DME & Oxygen/Respiratory Care
    • Home Health Care Providers
    • Hospice Care
    • Inpatient Acute Rehabilitation Hospitals, Sub-Acute & Skilled Nursing Care Facilities

    Care Delivery Programs

    • Care Management
    • Centers of Excellence Program
    • Clinical Decisions
    • Denials and Adverse Determination
    • Prescription Drug Management
    • Utilization Management

    Manual Topics

    • Appeals
    • Billing & Reimbursement
    • eServices & Online Solutions
    • Member Care
    • Network Operations & Care Delivery Management
    • Referral, Notification & Authorization

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