CommercialPrior AuthMedium impact
Prior authorization updates: Iron Workers Union product
Harvard Pilgrim Health Care·Orthopedics, Oncology, Physical Therapy·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
Harvard Pilgrim is introducing prior authorization requirements for Iron Workers Union members effective July 1, 2026, covering musculoskeletal spine services, joint surgeries, outpatient chemotherapy, and home health services. Different vendors will manage authorization requests for different service categories.
Action Required
Before July 1, 2026: Billing team must update workflow to identify Iron Workers Union members (ID numbers start with 'B' prefix, not 'HP'). Create authorization request protocols: contact Evolent at www.radmd.com or 800-642-7543 for spine/joint procedures, OncoHealth via HPHConnect portal or 888-916-2616 for chemotherapy, and Harvard Pilgrim at 617-509-1147 for home health services. Update encounter forms and staff training materials with these vendor-specific authorization requirements.