Harvard Pilgrim

Please follow the Enrollment Instructions below to become an electronic submitter for Harvard Pilgrim.


Please Note: Before Harvard Pilgrim will assign you a Direct Submitter ID, you must contact them to verify if your claim volume is sufficient for a direct connection. Otherwise, you may be required to submit your claims via a clearinghouse.

To verify the claim volume requirement, please call the Harvard Pilgrim EDI Technology Support Center at 1-617-509-8861.

 

Required Documents, If Harvard Pilgrim allows you to Submit Direct

The following documents are required enrollment documents that must be completed, signed and returned to the Harvard Pilgrim office prior to initiation of electronic claims submission or inquiry.

1. Enrollment Form

2. Trading Partner Agreement

If the above links do not work properly, please go here to download the forms:

www.harvardpilgrim.org

If you have any questions regarding any of the documents required, please call the Harvard Pilgrim EDI Technology Support Center
at 1-617-509-8861.

 

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

 

EDI Enrollment Form

Section 1

  • Enter your Business name, phone, fax and e-mail address

  • Enter the name and title of the contact person for your office, as well as your demographic information

Section 2

  • Place a check mark next to "Become a Trade Partner"

Section 3

  • For the 837 and 835 transactions check the boxes for SFTP

  • Choose whether you will be submitting Professional or Institutional claims or both

  • Leave the next three questions blank, since the submitter and sender ID are what you are applying for

Section 4

  • For Provider contact enter the name of your office manager and his or her phone number

  • For Vendor Contact Please enter the information for the software or vendor that creates your 837 files you need Claimshuttle to transfer for you. If you have paid for our billing software please call our support line for our software information.

  • For proposed Test Dates enter a date 2 weeks from today's date

  • Enter the information for the providers you will be billing for on the table provided

Signature Section

  • Have an authorized individual such as the Provider or Office Manager enter their Name, Title, Date and Signature

 

Trading Partner Privacy and Security Agreement

Complete the first paragraph on the first page of this document and complete the Contractor sections on page 6

 

Submitting your Forms

 

It is recommended that you keep a copy of all the forms you will be submitting for your records. Please Fax the enrollment forms to:

 

1-866-884-3844
 

It is very important that you complete and return the entire enrollment packet as described above. Incomplete documents will not be processed and will be returned to the submitter.

 

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt.

After processing, a confirmation will be emailed to you as notification to begin filling claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact Harvard Pilgrim EDI Technology Support Center at 1-617-509-8861.

 

Testing

Once you have received your Submitter ID and Password from Harvard Pilgrim, please call the Claimshuttle Support Team and set an appointment for a Mailbox Setup and Test Transmission.

Please have 2 batches of 40 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment, but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.