Harvard Pilgrim Health Care
Also covers / subsidiaries: HPHC, Harvard Pilgrim, Point32Health
Core Payer & Clearinghouse Profile
Electronic Payer ID
04271
Clearinghouse-confirmed; some self-funded business is processed by Health Plans Inc. and Medicare (Stride) routes separately.
Timely Filing Limit (TFL)
90 days from date of service (also applies to 1st- and 2nd-level appeals)
Appeal Window
Within 90 days; via HPHConnect / provider manual
Clearinghouse Gateway
EDI via clearinghouses; some self-funded business via Health Plans Inc.
Provider Services
Varies — confirm via portal / clearinghouse
Claims Fax
Varies — confirm via portal / clearinghouse
Claims Address
Stride (Medicare): c/o Stride Claims Processing, P.O. Box 211067, Eagan, MN 55121 (confirm per product)
Provider Portal
https://www.harvardpilgrimproviderportal.com/
Massachusetts plan under the same Point32Health parent as Tufts. Claims routing differs by product — match to the member's plan.
National EDI Clearinghouse Capabilities
Direct ANSI X12 electronic transaction support verified for Harvard Pilgrim Health Care.
Associated Clearinghouse Payer IDs
National clearinghouse networks maintain dedicated routing IDs for specific transaction lines or subsidiaries under Harvard Pilgrim Health Care.
| Clearinghouse Name | Electronic Payer ID | Status | Enrollment | Supported Services |
|---|---|---|---|---|
| Harvard Pilgrim | 04271 | Non-Par | Required | 837P837I835 ERA |
| Harvard Pilgrim Health Care | 04271 | Non-Par | Required | 837P837I835 ERA |
| Harvard Pilgrim Healthcare | 10376 | Non-Par | None | 837P837I270/271Dental |
| Point32 Health | P3201 | Par | None | 835 ERADental |
Resolution Tools for Harvard Pilgrim Health Care Claims
Values vary by plan, line of business, and provider agreement. Confirm in the payer portal or with your clearinghouse gateway before submitting electronic claims.
Tired of Chasing Harvard Pilgrim Health Care Denials & Delayed Payments?
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