Harvard Pilgrim Health Care
Welcome to the Harvard Pilgrim Health Care Health Plan page. The documents below have been designed to help RadMD users navigate the prior authorization process for each program Evolent is responsible for. Additional process-specific training tools and modules can be found via links on the Resources tab at the top of the screen.
If you have any questions about our programs, please contact your dedicated Evolent Provider Engagement Manager:
- Lori Fink (Advanced Imaging/Cardiology/Sleep)
- Mara Grimm (Interventional Pain Management/Musculoskeletal)
Massachusetts Imaging Prior Authorization Form
Advanced Imaging, Diagnostic Cardiology and Sleep Program
- Cardiac Frequently Asked Questions
- Frequently Asked Questions
- Peer-to-Peer Process
- Provider Education Presentation
- Sleep Assessment Record Checklist
- Utilization Review Matrix - Commercial
For access to our Advanced Imaging tip sheets/checklists, click here.
For access to our Cardiac tip sheets/checklists, click here.
For access to our Sleep Solutions checklists, click here.
Musculoskeletal and Interventional Pain Management Program
- Frequently Asked Questions
- Provider Education Presentation
- Utilization Review Matrix (IPM)
- Utilization Review Matrix (MSK - Hip, Knee and Shoulder)
- Utilization Review Matrix (MSK - Spine Surgery)
For access to our Musculoskeletal tip sheets/checklists, click here.
For access to our Interventional Pain Management tip sheets/checklists, click here.
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
Clinical Guidelines
- Clinical Guidelines
- Refer to the Utilization Review Matrix document to view specific codes managed by Evolent.