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:
If you have any questions regarding any of the documents required, please call the Harvard Pilgrim EDI Technology Support Center
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
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
Place a check mark next to "Become a Trade Partner"
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
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
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:
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.
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.