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