How to Submit a Superbill to Harvard Pilgrim Health Care for Therapy Reimbursement

Harvard Pilgrim Out-of-Network Process

Harvard Pilgrim Health Care, now part of Point32Health, serves members in New England. OON mental health benefits are available on PPO plans. Members submit superbills through the Harvard Pilgrim member portal at harvardpilgrim.org or by mailing a completed claim form with the superbill. Harvard Pilgrim's behavioral health division processes OON claims and may require a referral from a Harvard Pilgrim primary care provider for some plans.

Common Denial Reasons

• ✗Member has an HMO plan that does not cover OON mental health services
• ✗No referral on file from the member's Harvard Pilgrim primary care provider
• ✗Provider's NPI not listed in NPPES or has not been updated within the past year
• ✗Claim submitted after the 180-day timely filing window

Tips for Getting Reimbursed by Harvard Pilgrim

• ✓Harvard Pilgrim and Tufts merged under Point32Health — some members may have combined ID cards
• ✓PPO members have the best OON mental health access — confirm plan type before the first session
• ✓New England's strong mental health parity laws support favorable OON reimbursement rates
• ✓Encourage clients to request a case manager through Harvard Pilgrim if they need help navigating OON benefits