Provider Training Guides
We’re here to guide and support you. Our handy guides and reference materials offer step-by-step instructions to help staff with e-transactions and other operations.
Harvard Pilgrim Health Care
We’ve developed HPHConnect user guides and reference materials to give you step-by-step instructions on conducting e-transactions through our secure portal. If you have any further questions, contact our Provider eBusiness Services team at [email protected] or call 800-708-4414 (Option 1; then press 6).
Account Maintenance Documents
Basic Features
- Verify member eligibility
- Verifying Claims Status and Remittance Advice
- Referral/Auth Transaction Status
- Look Up a Diagnosis or Procedure Code
- Look Up Provider Information
- Performing Referral/Auth Searches User Guide
- Making a PCP Change in HPHConnect
Behavioral Health
Provider Data
Claims Management
- Claims Submission – Professional Claims Submission User Guide
- Document Manager – Submitting HIPAA Compliant Transactions User Guide
Reports
- Member Roster User Guide
- Member Roster Quick Reference Sheet
- Negative Balance Report User Guide
- Non-Utilizer Report User Guide
- Provider Analytics User Guide
- Refund Report User Guide
- Transaction Report User Guide
Provider Notifications
Referral, Authorization and Notification Entry Instructions
- Acute Care Hospital Admission User Guide
- Durable Medical Equipment (DME) Quick Reference Sheet
- Habilitative & Rehabilitative Therapies User Guide
- Home Health Care Authorization Request User Guide
- Home Infusion Therapy (How to Submit Additional Information) User Guide
- Hospice – Respite Care User Guide
- Hospice – Respite Care Quick Reference Sheet
- IVIG Services in the Home Quick Reference Sheet
- IVIG Services in Other than the Home Quick Reference Sheet
- Outpatient Advanced Imaging Notification Quick Reference Sheet
- Outpatient Pharmacy Service Transactions Quick Reference Sheet
- Rehabilitation Inpatient Admission Authorization User Guide
- Skilled Nursing Care Inpatient/Long Term Care Admission User Guide
- Submitting Physician Referrals User Guide
- Surgical Day Care Services User Guide
- Transportation—Medical Related Transport User Guide
Tufts Health Plan
Printable guides and resources for providers
Secure Provider Portal
- Tufts Health Plan Secure Provider Portal User Guide
- MHK Portal User Guide (Commercial, Tufts Health Public Plans, Tufts Medicare Preferred)
- Claim Status Inquiry
- Eligibility and Benefits Inquiry
- Online Claim Adjustments
- Referral Inquiry
- Referral Submission
- Inpatient Notification Submission and Inquiry
- Prior Authorization Submission and Inquiry
- Senior Access Administrator (SAA) and Access Administrator (AA) Guide to User Management Tools
Tufts Health Plan Senior Care Options (SCO)
- Care Model Training
- Continuing Education Resources
- Identifying and reporting elder abuse and neglect
- Plan Overview
Tufts Health Public Plans
Behavioral Health
- Behavioral Health Provider Resource Guide
- Behavioral Health MHK Portal User Guide (for Commercial and Tufts Medicare Preferred)
Provider Resource Guides
- Commercial Provider Resource Guide
- Interpreting MHK Authorization Correspondence
- Out of Network Provider Resource Guide
- Senior Products Provider Resource Guide
- Tufts Health Public Plans Massachusetts Products Provider Resource Guide
- Tufts Health Public Plans Rhode Island Products Provider Resource Guide