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 (formerly National Imaging Associates, Inc.) 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 Relations Manager, Seth Cohen. 

MEDICARE plans: Effective 8/5/2024, peer-to-peer discussions must be performed before a final determination has been made on the request. Medicare re-opens are only allowed if the request complies with the CMS definition of a re-open. Providers will continue to have the option to submit an appeal utilizing the health plan’s process. 

For dates of service beginning June 24, 2019, the following cardiac procedures will require prior authorization for our commercial members: Cardiac Resynchronization Therapy (CRT), Implantable Cardioverter Defibrillator (ICD), Pacemaker Insertion, Transthoracic Echocardiography (TTE), Transesophageal Echocardiography (TEE), Stress Echocardiography, Heart Catheterization. (These procedures began requiring prior authorization for our Medicare Advantage members on Jan. 1, 2019).

Conservative Treatment Forms  

For access to our conservative treatment forms, click here.