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Guide to navigating pre-service clinical appeals
Harvard Pilgrim Health Care·Provider Newsletter
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Jun 20, 2026
Summary
Point32Health (Harvard Pilgrim Health Care and Tufts Health Plan) has released a new comprehensive guide for submitting pre-service clinical appeals when providers disagree with utilization management coverage denials. The guide provides step-by-step instructions for appealing coverage decisions on behalf of members, with submission processes that vary by product type.
Action Required
Immediately: Billing and clinical staff should access and review the new Guide to navigating pre-service clinical appeals from Point32Health's provider website. Add the guide and Provider Claims Appeals flyer to reference materials for staff handling coverage denials. Train staff on the distinction between pre-service UM appeals (coverage denials) and claims appeals (reimbursement disputes).