CommercialAdministrativeMedium impact
Opted out of Medicare: Submit form with claims
Harvard Pilgrim Health Care·Provider Newsletter
Effective date
Jun 1, 2026
We identified it
Jun 20, 2026
Summary
Starting June 1, 2026, providers who have opted out of Medicare must submit a specific opt-out form with every claim for Harvard Pilgrim Health Care members who have Medicare as primary insurance. Claims will be denied if the form is not submitted with each claim.
Action Required
Before June 1, 2026: If your practice has opted out of Medicare, billing team must obtain Harvard Pilgrim opt-out forms and establish process to submit completed form with every claim for Harvard Pilgrim Commercial, Medicare Enhance, or Medicare Supplement members who have Medicare as primary. Mail forms to Harvard Pilgrim Health Care, P.O. Box 699183, Quincy, MA 02269-9183. Failure to submit form will result in claim denial.