Change in denial process for lack of prior authorization
We’re making a change to our claim adjudication process for ancillary services billed in connection with services requiring prior authorization when the authorization is not obtained.
MassHealth coverage: anti-obesity medications
We will no longer cover the specified drugs for the treatment of obesity or overweight for members of certain plans.
Continuous glucose monitors coverage
We will no longer provide coverage for Dexcom continuous glucose monitors (CGMs) and their accompanying supplies — including new starts and those with previous approvals.
Survey for ABA providers
We encourage ABA providers to complete this anonymous MassHealth survey focused on hiring and staffing practices. Findings will inform health policy development aimed at strengthening workforce capacity, service quality, and outcomes for the populations served. If you have received this survey from another plan or trade organizaiton and completed it, you do not need to do so again. Responses are due by Friday, May 15th.
About the HPHConnect secure portal
Learn about HPHConnect, our secure web-based transaction service for Harvard Pilgrim products, including how to register and submit transactions.
About the Tufts Health Plan secure portal
Learn about the web-based transaction service for Tufts Health Plan products, including how to register and submit transactions.
Electronic data interchange services (EDI)
Visit the EDI page to learn more about trading partners, getting set up for electronic transactions and to access companion guides.
Electronic payment
Visit our electronic funds transfer (EFT) page to get started with receiving your reimbursement electronically.
Vendor programs
Learn about vendor partners who conduct utilization management for certain services.
Join the network
We invite you to join us in ensuring that our communities have access to high-quality, equitable health care by becoming a participating provider.
View our plans
Learn more about the diverse range of health plans we offer under our legacy brands, Harvard Pilgrim Health Care and Tufts Health Plan.