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  • Harvard Pilgrim Health Care Accident Questionnaire

Get Harvard Pilgrim Health Care Accident Questionnaire

Questionnaire Member Name: HPHC ID: Date of Service: Was the injury/illness related to: Auto/Motorcycle Accident No Accident Work/Industrial Accident Other (slip & fall) Accident If this is Auto/Motorcycle.

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Harvard Pilgrim and Optum/United Behavioral Health, our behavioral health partner, can help facilitate the coordination of care, and make a number of resources available to Harvard Pilgrim providers.

The Passport ConnectSM program is an alliance between UnitedHealthcare and Harvard Pilgrim Health Care and offers your employees a “passport” to Harvard Pilgrim's highly regarded physician and hospital network, in addition to UnitedHealthcare's national network—all under one plan.

Provider coverage includes Harvard Pilgrim's network in Massachusetts, New Hampshire and Maine, and our national network partner, UnitedHealthcare Options for the remaining states. In addition to the Harvard Pilgrim and United Options networks, members may see an out of network provider, at a higher cost.

Claims Requirements Standard Filing Limit • 90 days from the date of service. Members may not be billed for services submitted after the filing limit.

Harvard Pilgrim Health Care Bridgeport Hospital. Bristol Hospital. Charlotte Hungerford Hospital. ... Addison Gilbert Hospital. Anna Jaques Hospital. Athol Memorial Hospital. ... Alice Peck Day Memorial Hospital. Androscoggin Valley Hospital. Catholic Medical Center. ... Blue Hill Memorial Hospital. Bridgton Memorial Hospital.

Request Electronic Claim Submission To initiate a request to submit electronic claims directly, contact the EDI Team at edi_team@point32health.org or call the EDI Team at 800-708-4414, option 1, option 3. Harvard Pilgrim does not require pre-enrollment for electronic claims submitted through a clearinghouse.

Contact the Provider Call Center at 1-800-708-4414, if you have questions.

Yes: durable medical equipment, emergency room care, emergency medical transportation, outpatient mental health services, preventive care, provider office visits, rehabilitation services, habilitation services, routine eye exams are covered before you meet your deductibles.

After you meet your out-of- pocket maximum, Harvard Pilgrim will pay all additional covered health care costs. The out- of-pocket maximum is $2,500 per person and $5,000 per double/family. The Schedule of Benefits has more details on benefits and cost sharing.

A Point32Health company. Point32Health is the parent organization of Harvard Pilgrim Health Care and Tufts Health Plan. Together, we're delivering ever-better health care experiences to everyone in our diverse communities.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232