Quick Reference Guide Step 4 Section B requires the prescribers information. Mail us Canton, MACorporate Headquarters Harvard Pilgrim Health Care 1 Wellness Way Canton, MA 02021 Together, we're delivering ever-better health care experiences to everyone in our diverse communities. Step 1 - Begin by downloading the Harvard Pilgrim HealthCare Medication Request Form in Adobe PDF. You can provide the requisite information by hand or on your computer. Additional languages upon request . Need to submit a claim? Notification or Prior Authorization Appeals. Harvard Pilgrim Insurance Phone Number for Brokers: Broker Employer Service Team. Emergent Department/Urgent Admission Notification. Also signify the reason for the request and check the applicable box if the request is to be expedited. Call (888) 333-4742, TTY: 711. If yes, describe the improvements in the available field. Representatives are available Monday through Friday, 8:00 am to 6:00 pm (ET), Privacy PolicySurprise Medical Bills Transparency in Coverage - Machine Readable Files Translation Disclaimer Sitemap, Corporate Headquarters1500 West Park Drive, Suite 330Westborough, MA 01581Directions, Phone: 508-752-2480Toll-free: 800-532-7575Fax: 508-754-9664, Health Plans, Inc. is a Harvard Pilgrim company. . If yes, describe. If nonpharmacologic therapies were attempted, provide more information. 1500 West Park Drive, Suite 330 Westborough, MA 01581 508-752-2480 Toll-free: 800-532-7575 Fax: 508-754-9664 Next, check yes or no to indicate whether the patient is currently being treated by the requested drug. HPI Corporate Headquarters PO Box 5199 Westborough, MA 2 of 2 01581 800-532-7575 . Claims Standard Medical Claim form. Step 1 Begin by downloading the Harvard Pilgrim HealthCare Medication Request Form in Adobe PDF. page for additional prior authorization information. Policies, Clinical Coverage Criteria and Request Forms, Network Operations & Care Delivery Management, Emergent Department/Urgent Admission Notification, Non-Invasive Airway Assist Devices (CPAP, APAP, and BiPAP) and Related Sleep Therapy Supplies Notification Policy, Prior Authorization Medical Review Criteria, Medical Drug Program (CVS HealthNovoLogix). Notification Policy. Prior authorization allows the prescriber to request coverage for their patient prior to prescribing the preferred medication. Often this is required if the prescription drug being administered is atypical. Notify Harvard Pilgrim of inaccurate information found in our Find a Provider directory. Elective Admission Notification. NOTE: E-mail may not be encrypted. Contract Rate, Payment Policy, or Clinical Policy Appeals. Step 3 In the first window, enter the patients name, date of birth, member ID #. 800-424-7285, choose option # 1. The Harvard Pilgrim Healthcare Medication Request Form can be used for a number of purposes, one of which is prior authorization. If you are not a Harvard Pilgrim member, you can send an email here. For any compound or off label use, include citation to peer reviewed literature where applicable. You can provide the requisite information by hand or on your computer. Harvard Pilgrim Health Care is a non-profit health services company based in Canton, Massachusetts serving the New England region of the United States.. On August 14, 2019, the boards of Harvard Pilgrim Health Care and Tufts Health Plan announced plans for the two insurers to merge their organizations into a new company. Point32Health Recognized as one of the 50 Most Community-Minded Companies in the Country. Step 7 In Section E, enter in the below info. Commercial Clinical/Authorization Policies, Medical Benefit Drugs: Medical Necessity Guidelines, About Our StrideSM (HMO)/(HMO-POS) Medicare Advantage Plans, Medicare Advantage Clinical/Auth. The new company serves 2.4 million members in Massachusetts, Maine . Harvard Pilgrim Health Care Contact Phone Number is : 1-888-888-4742. and Address is Harvard Pilgrim Health Care 1600 Crown Colony Drive, Quincy, Massachusetts 02169. Call 1-888-333-4742 (TTY: 711). Enter the medication name, strength, dosing schedule, quantity, length of therapy, and therapy start date to begin. Non-Invasive Airway Assist Devices (CPAP, APAP, and BiPAP) and Related Sleep Therapy Supplies Notification Policy. More news. Prior Authorizations Please note: Prior authorization requirements vary by plan. This will include all of the following info: Step 5 Now info on the requested medication can be supplied. Point32Health has been named a 2022 honoree of The Civic 50 by Points of Light, the world's largest nonprofit dedicated to volunteer service. Request for Additional Information Appeals. ProvAppeal_HPI-HPHC _website_form+QRG. Phone number (617) 509-1000. (eligibility, billing, benefits and claims) Mon to Fri 8 AM to 5 PM. 1600 Crown . It provides a wide range of Insurance plan coverage choICEs and self-funding preparations to more than . Page. Step 2 - Identify the use of the form; whether it's an initial request or a continuation/renewal request. Step 2 Identify the use of the form; whether its an initial request or a continuation/renewal request. HPHConnect is Harvard Pilgrim's highly acclaimed Web-based transaction service for our commercial plans. Harvard Pilgrim Healthcare Prior Prescription Authorization Form. It's free, available 24/7, and is HIPAA-compliant. Get Directions. Provider Appeal Policies. Members can send a secure email to Member Services. Phone: 508-752-2480 Toll-free: 800-532-7575 Step 11 Any additional information that may be useful in this request can be supplied in the final window. Harvard Pilgrim Healthcare Prior Prescription Authorization Form. Harvard Pilgrim Provider Appeal form and Quick Reference Guide. Step 9 The relevant lab values must be supplied in this table along with the requisite documentation. Prior Prescription (RX) Authorization Forms, Harvard Pilgrim Healthcare Prior Prescription (Rx) Authorization Form, CVS Prior Prescription (Rx) Authorization Form, Fidelis Prior Prescription (Rx) Authorization Form, CDPHP Prior Prescription (Rx) Authorization Form, CIGNA Prior Prescription (Rx) Authorization Form, AETNA Prior Prescription (Rx) Authorization Form, Catamaran Prior Prescription (Rx) Authorization Form, Express Scripts Prior Prescription (Rx) Authorization Form, Anthem Blue Cross / Blue Shield Prior Prescription (Rx) Authorization Form, Harvard Pilgrim HealthCare Medication Request Form, Harvard Pilgrim Healthcare Prior Prescription Authorization Form, Authorization Forms Adobe PDF and Microsoft Word, Prescribing clinician signature (after printing if applicable), Is medication injectable and to be self-administered (yes or no), For quality limit exception requests, provide rationale (if applicable). Here you can submit batch claim files, verify patient eligibility, send/receive specialty referrals, submit authorization requests, and more. Harvard Pilgrim was established in 1980. Duplicate Denial Appeals. LOGIN or REGISTER Key Contacts If relevant to the request, supply the following: Step 6 If this form is being used for a renewal request, indicate whether or not the patient has experience improvement while on the prescribed medication. Filing Limit Appeals. 9 reviews of Harvard Pilgrim Health Care "I am a provider of physical therapy and Harvard Pilgrim Health Care is THE WORST at covering necessary health care expenses. NICU Notification Policy. It is a not-for-profit health plan. 800- 424-7285 , choose option # 2. Point32Health is the parent organization of Harvard Pilgrim Health Care and Tufts Health Plan. Please contact HPI Provider Services or visit Access Patient . For most members, claims can be mailed or submitted electronically to us at the address or payer ID's below; however, the address and payer ID's may vary based on member-specific plans and networks. Review the claim submission address or electronic payor ID # on the back of the patient's member ID card. When a Notification is Not Required. The healthcare provider must complete the form in full, providing a list of previously applied treatments and their justification for requesting an alternative drug. ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. 2022 Harvard Pilgrim Health Care, Inc. All rights reserved. Referral Denial Appeals. Step 8 List all previous therapies, and then answer whether there are contraindications to alternative therapies. Step 10 If the medication is a compound, check Yes and provide the ingredients. Print off the document once double checked for accuracy, provide the required signature, and fax the completed form to(888) 807-6643. Closed for training on Wed 8.30 AM to 10 AM) Broker Relations. Standard Dental Claim form. We treat a LOT of patients and there is no insurance company that is worse. Please use your discretion when submitting confidential or personal information.
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