A reminder that effective July 6, 2010, all NHP members with a Harvard Vanguard Medical Associates PCP will be required to obtain an appropriate referral from their PCP when seeking care from a non-Harvard Vanguard specialty provider.
Referrals are not required for the following:
A Gynecologist or Obstetrician for routine, preventive, or urgent care
Family planning services provided by an NHP provider
Outpatient and diversionary Behavioral Health Services
Emergency services
NHP is making these changes to help enhance care coordination for those NHP members with a Harvard Vanguard primary care provider (PCP).
This referral requirement applies to Harvard Vanguard patients participating in all NHP plans: Commercial, Commonwealth Choice, Commonwealth Care, CMA, and MassHealth. Please note that for NHP members who are enrolled through the Group Insurance Commission (GIC), this change is effective for services rendered on or after September 1, 2010.
To avoid claims denials, providers should verify the existence of an appropriate referral for members with a Harvard Vanguard PCP prior to services being rendered.
Those members affected by this change as well as the NHP provider community, have been notified of the new referral requirements. As always, please contact your Provider Relations representative directly with any questions or our Customer Care Center at 800-462-5449.