CommercialPrior AuthMedium impact
Maternity health benefit reminder
Harvard Pilgrim Health Care·OB-GYN, Family Medicine, Emergency Medicine·Provider Newsletter
We identified it
Jun 20, 2026
Summary
Point32Health (Harvard Pilgrim and Tufts Health Plan Commercial) reminds providers that normal obstetrical deliveries do not require inpatient notification, but acute inpatient hospitalizations for pregnancy complications (not planned deliveries) still require prior authorization.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for acute inpatient hospitalizations due to pregnancy complications (not planned deliveries) for Harvard Pilgrim and Tufts Health Plan Commercial members. Submit prior authorization requests electronically through HPHConnect and Tufts Health Plan secure provider portals. Claims for complicated pregnancy hospitalizations will be denied without prior authorization.