Harvard Pilgrim Health Care
Harvard Pilgrim Health Care is a payer organization operating in Massachusetts, Maine, New Hampshire, and 2 more states. For an ASC, what matters isn't the logo. It's how Harvard Pilgrim Health Care pays: where it runs rich, where it runs thin, and how its reimbursement compares with peer plans for the same procedures.
Pilot Analysis
Get the complete Harvard Pilgrim Health Care analysis
Tell us where to send it. Our team will prepare an analysis of Harvard Pilgrim Health Care covering rates by code, market position, and underpaid areas, and email it to you within 5-10 business days. Need it faster? Book a demo.
What Insights reveals
How Harvard Pilgrim Health Care pays
See how Harvard Pilgrim Health Care reimburses across procedures and markets, benchmarked against the peer plans competing for the same cases. Not a raw rate sheet, a read on where it sits.
Geographic footprint
Harvard Pilgrim Health Care's presence spans Massachusetts, Maine, New Hampshire, and 2 more states. See where it concentrates and how that shapes the markets you compete in.
Peer position
Put your own position next to the benchmark for Harvard Pilgrim Health Care and bring the gap to your next contract conversation.
Specialty mix
Understand which procedures and specialties drive Harvard Pilgrim Health Care's volume, so you know where a rate change moves the needle.
Whether you're an ASC benchmarking a contract or a provider team looking Harvard Pilgrim Health Care up, DataLily AI maps how it reimburses across procedures and markets, and where your own rates sit against the peer benchmark.
Reference
Working with Harvard Pilgrim Health Care
- Payer ID
- 04271 is the EDI identifier used to route electronic eligibility checks (270/271), claim-status inquiries (276/277), and claims to Harvard Pilgrim Health Care through a clearinghouse.
- Eligibility verification
- Coverage and benefits for Harvard Pilgrim Health Care members are verified before the date of service, through a clearinghouse using payer ID 04271or through the payer's provider portal.
- Prior authorization
- Requirements are set per plan and per procedure. Confirm whether an authorization is required with Harvard Pilgrim Health Care directly before the date of service.
Book a demo: pick a time
A 15-minute walkthrough of Harvard Pilgrim Health Care the way it pays.
- What is Harvard Pilgrim Health Care's payer ID?
- Harvard Pilgrim Health Care's electronic payer ID is 04271. ASC billing teams use it to route eligibility checks (270/271), claim-status inquiries (276/277), and electronic claims to Harvard Pilgrim Health Care through a clearinghouse.
- How do ASCs verify eligibility for Harvard Pilgrim Health Care members?
- Eligibility and benefits for Harvard Pilgrim Health Care members are verified before the date of service, either electronically through a clearinghouse (a 270/271 transaction using payer ID 04271) or through the payer's provider portal.
- Does Harvard Pilgrim Health Care require prior authorization for ASC procedures?
- Prior-authorization requirements for Harvard Pilgrim Health Care are set per plan and per procedure. Confirm whether an authorization is required with Harvard Pilgrim Health Care directly before the date of service.
- What type of payer is Harvard Pilgrim Health Care?
- Harvard Pilgrim Health Care is a payer organization operating in Massachusetts, Maine, New Hampshire, and 2 more states.
- How does Harvard Pilgrim Health Care compare with other payers for ASC procedures?
- Ask Rose and you get a plain-language read on where Harvard Pilgrim Health Care pays above or below peer plans for your top procedures, charted, and ending in a recommendation you can take into a contract conversation.
- Is Harvard Pilgrim Health Care paying my ASC below market?
- Put your own Harvard Pilgrim Health Care contract next to the peer benchmark in DataLily AI and you'll see the gap by procedure and market, the fastest way to know whether you're leaving money on the table.