Harvard Pilgrim at a glance
| Legal name | Harvard Pilgrim Health Care, Inc. |
|---|---|
| Also known as | Harvard Pilgrim Health Care, HPHC |
| Category | Commercial |
| Parent organization | Point32Health |
| Claims payer ID | Select the current Harvard Pilgrim product in Point32Health resources. Stride HMO/HMO-POS ended 1/1/2025 and its published claim runout ended 12/31/2025; historical 04245 must not be offered as an active universal route. |
| Eligibility (270/271) payer ID | 04271 — registry reference; verify the member product, transaction and clearinghouse |
| ERA (835) payer ID | 04271 — registry reference; verify the member product, transaction and clearinghouse |
| NAIC company code | Not established in this registry |
| States covered | Massachusetts, New Hampshire, Maine, Connecticut |
| Members covered | ~1.1 million members |
| Provider resource entry point | https://www.point32health.org/provider |
| Provider phone | 1-800-708-4414 |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for Harvard Pilgrim
This registry lists 90 days as an initial-claim reference for Harvard Pilgrim. Confirm the applicable product, provider agreement, start event and current payer instructions. Do not apply this value automatically to out-of-network, secondary, corrected or appealed claims.
| Submission type | Window |
|---|---|
| Initial claim reference | 90 days (verify applicability) |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
This registry has not established a payer-specific appeal ladder for Harvard Pilgrim. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: Harvard Pilgrim provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Harvard Pilgrim
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify Harvard Pilgrim electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for Harvard Pilgrim. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for Harvard Pilgrim
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Harvard Pilgrim volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | Select the current Harvard Pilgrim product in Point32Health resources. Stride HMO/HMO-POS ended 1/1/2025 and its published claim runout ended 12/31/2025; historical 04245 must not be offered as an active universal route. |
| 270 / 271 eligibility | Listed in registry; verify current scope | 04271 — registry reference; verify the member product, transaction and clearinghouse |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | 04271 — registry reference; verify the member product, transaction and clearinghouse |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
portal_url
Source comparison: 2026-09-26
Stored HarvardPilgrim provider URL redirects to current Point32Health provider hub; retain product selection.
Primary source for portal_urlpayer_ids.claims
Source comparison: 2026-09-26
The explicit Stride closure is limited to that discontinued MedicareAdvantage product and historical 04245. Do not renew 04271 as a universal HarvardPilgrimclaims/ERA/eligibility ID or treat allHarvardPilgrim as closed.
Primary source for payer_ids.claims
Not checked in this pass: Whole-record approval, legal identity, ownership and complete product coverage; Authenticated transactions and QuickIntell integrations; timely_filing_days: Stride historical 365-dayrunout and older commercial 90-day search leads are different scopes. No current universal 90-day filing finding is approved.; record_scope: Not verified by the retrieved sources in this bounded comparison; retain explicit uncertainty and do not infer from another field or organization.; provider_phone: Not verified by the retrieved sources in this bounded comparison; retain explicit uncertainty and do not infer from another field or organization.; payer_ids.eligibility / payer_ids.era / era_payer_id: No current transaction-specific eligibility/ERA identifier evidence was verified; do not reuse claim identifiers.; electronic_claims_supported / supports_279_271 / supports_278: Not verified by the retrieved sources in this bounded comparison; retain explicit uncertainty and do not infer from another field or organization.; appeal_levels / prior_auth_required_codes_sample / qi_module_coverage: Not verified by the retrieved sources in this bounded comparison; retain explicit uncertainty and do not infer from another field or organization..
Sources used for this guide
State coverage
Harvard Pilgrim operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
Evaluate QuickIntell workflow fit for Harvard Pilgrim
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for Harvard Pilgrim; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Harvard Pilgrim; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Harvard Pilgrim before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Harvard Pilgrim
Where is the Harvard Pilgrim provider portal?
Use https://www.point32health.org/provider as a starting point for Harvard Pilgrim provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for Harvard Pilgrim?
This registry lists 90 days as an initial-claim reference for Harvard Pilgrim. Confirm the applicable product, provider agreement, start event and current payer instructions. Do not apply this value automatically to out-of-network, secondary, corrected or appealed claims.
What is the Harvard Pilgrim payer ID?
Claims: Select the current Harvard Pilgrim product in Point32Health resources. Stride HMO/HMO-POS ended 1/1/2025 and its published claim runout ended 12/31/2025; historical 04245 must not be offered as an active universal route.. Eligibility (270/271): 04271 — registry reference; verify the member product, transaction and clearinghouse. ERA (835): 04271 — registry reference; verify the member product, transaction and clearinghouse. Do not substitute a claims ID for an unverified transaction ID. Check current source findings and the member ID card before submitting.
Does Harvard Pilgrim accept electronic claims?
Verify Harvard Pilgrim electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a Harvard Pilgrim denial?
This registry has not established a payer-specific appeal ladder for Harvard Pilgrim. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do Harvard Pilgrim prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the Harvard Pilgrim provider phone number?
This registry lists 1-800-708-4414 as a contact reference for Harvard Pilgrim. Confirm the number and service scope against the member ID card and current product-specific directory; claims, eligibility and authorization inquiries may use different teams.
Automate workflows around Harvard Pilgrim requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against Harvard Pilgrim's current published documents before submission. CPT® is a registered trademark of the American Medical Association.