Harvard Pilgrim Stride^SM Medicare Advantage Plan

As we noted in the October issue of the provider newsletter, we recently made the decision to discontinue our Harvard Pilgrim Health Care Stride^SM (HMO/ HMO-POS) Medicare Advantage plans in New Hampshire, effective Jan. 1, 2025. As of that date, the product will no longer be available.

Please continue to provide services to Stride^SM (HMO/HMO-POS) Medicare Advantage members through the end of the year and submit claims as you do today. We will process claims through the claims timely submission time frame for Stride, which is 365 days post date of service. While members will continue to have access to their Stride benefits and services through the end of the year, we are encouraging the approximately 10,000 affected members to seek out alternative options available in the market.

We’re continuing to make the following resources available to you as you continue to submit claims for Stride^SM (HMO/HMO-POS) Medicare Advantage members.

Helpful Resources:

• Provider Portal for Medicare Advantage
• Stride^SM (HMO/HMO-POS) Medicare Advantage Provider Manual
• Quick Reference Guide and Referral/Auth Quick Reference Guide

Pharmacy:

• Pharmacy Formulary
• Medicare Rx Determination Form
• Pharmacy PA Requirements 
• Pharmacy Step Therapy Requirements

Claims and Referral Forms:

• Claim Overpayment Refund Form
• Claim Review Form
• Claims Appeals Form
• Referral Form

Prior Authorization Forms: 

• Bariatric Surgeries
• Breast Surgery
• Cholecystectomy
• DME (includes Continuous Glucose Monitoring Systems)
• Hysterectomy
• Implantable Neurostimulators
• Medicare Advantage Prior Authorization Request Form
• Post-Acute Care Admission for SNF, LTAC, and Acute Rehab 
• Reconstructive Restorative Skin Procedures
• Sinus Surgeries
• Transportation
• Urinary Incontinence Surgeries