Harvard Pilgrim Health Care
CommercialAlso covers: HPHC, Harvard Pilgrim, Point32Health
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
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.
Values vary by plan, region, and contract and can change. Confirm in the payer portal or with your clearinghouse before filing.
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