Harvard Pilgrim Health Care has provided an update that includes the restoration of invoices for premiums and administrative fees for Commercial employer group clients and restoring claims invoicing for ASO accounts.

This restoration also includes impacts to individual members (including Buy Direct, Medicare Supplement, and those who purchase through the Maine and New Hampshire exchanges).

Employer Group Premium Invoices & Administrative Fees

   May:

• All paper and paperless invoices, and Online Billing Cycle 15 invoices for May premium and administrative fees were distributed prior to the outage.
• Online Billing Cycles 20 and 25 invoices for May premiums were not generated — and will be included in the July invoice, per the schedule below.
• The May AutoPay/ACH was not withdrawn on May 1, 2023. These funds are now scheduled to be withdrawn on June 12, 2023.
• For clients that submitted May premium or administrative fee payment via check or wire transfer during the outage, HPHC will process that payment, and no premium will be withdrawn. If there is an email address on file for the client, an automated email message will be sent prior to the withdrawal.

   June and July:

• July premium and administrative fee invoices will be generated this month and will include both June and July. If the client is in the Online Billing Cycles 20 or 25, the invoices will also include May premiums. The due date for these invoices is July 1, 2023. All clients will receive paper invoices, even if they are signed up for paperless billing.
• For clients enrolled in AutoPay/ACH, June and July premium or administrative fees will be withdrawn on July 3, 2023.
• For clients in Online Billing Cycles 20 and 25, the July 3, 2023. AutoPay/ACH withdrawal will include the May, June and July premiums.
• Please note: premiums and administrative fees will be calculated based on membership as of April 14, 2023. All enrollment transactions from April 15, 2023 to present (i.e., new members or terminations) will appear as adjustments on future invoices once enrollment data systems are fully restored.

For questions on employer client invoicing and payments please email myserviceteam@point32health.org.

ASO Account Claims
HPHC has started to process medical claims received prior to the outage and expects to begin processing and adjudicating new claims shortly. During this time, ASO clients may experience higher than normal medical claims invoices; HPHC anticipates claims processing to normalize within a few months.

Please note that vended claims, including pharmacy and behavioral health, continue to be held, so the higher-than-normal medical claims invoices may temporarily be offset by lower vended claims.

• For clients on weekly invoicing:

• • Invoices for medical claims will begin on June 8, 2023 and clients will receive three (3) invoices inclusive of the April 20, June 1 and June 8 billing periods for claims received prior to the outage.
    • For clients with AutoPay/ACH, HPHC will begin withdrawing funds on June 9, 2023 for the three invoices listed above.
  • HPHC will resume weekly claims invoicing on June 15.

• For Monthly Level Funding invoicing:

• Clients have continued to pay per the payment schedule.
• Clients will receive first quarter reconciliation on June 5, 2023.

For questions about claims invoices and payments, please contact the client’s account manager or sales executive.

Additional Resources
Latest updates and FAQs can be viewed here: point32health.org/systemupdate.