CommercialPrior AuthMedium impact
Continuity of care for patients switching health plans
Harvard Pilgrim Health Care·Provider Newsletter
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Starting January 1, 2026, Point32Health (Harvard Pilgrim and Tufts Health Direct) will honor existing prior authorizations from patients' previous insurers for 90 days when they switch to these plans. Providers must submit proof of the prior authorization by fax to continue services without interruption or new medical necessity review.
Action Required
By January 1, 2026: Billing team must establish workflow to identify new Harvard Pilgrim Commercial and Tufts Health Direct members switching from other insurers. For patients with existing prior authorizations, fax proof of authorization (previous provider info, dates of service, CPT codes, units/visits authorized, authorization number) to Harvard Pilgrim (800-232-0816) for medical services or behavioral health services to appropriate fax numbers. For pharmacy, call Provider Service Centers for 30-day extensions. Update front desk staff to collect prior authorization documentation from new members during registration.