Currentharvard pilgrim health carePolicy N/A

Negative Balance

Governs Harvard Pilgrim's handling, reporting, and recovery of negative balances created when previously paid claims are retracted or re-adjudicated; affects providers submitting claims and administrators with claims/AR access.

Policy Summary

Payerharvard pilgrim health care

PolicyNegative Balance

Policy CodePolicy N/A

Change TypeRevised (operational clarifications)

Effective DateN/A

Next Review DateN/A

Key ActionProviders can view the Negative Balance Report via HPHConnect (Back Office role or higher) and direct inquiries to 800-708-4414 or AR_Negative_Balance@point32health.org.

SourceLink

POLICY UPDATE CHANGES

Updated Retraction Causes and Negative Balance Recovery sections

added contact information to negative balance report

administrative edits and reviews noted in publication history

90 daysrecovery period (refund letter issued after)

HPHConnectportal

PLBreporting segment

800-708-4414inquiry contact

Retraction Causes and Recovery Actions

Circumstances and recovery actions that lead to creation and resolution of negative balances include:

ALL of the following

ONE of
- Duplicate payment
- Payment to the wrong provider
- Payment for the wrong member
- Retroactive termination of a member

Policy Summary

Payerharvard pilgrim health care

PolicyNegative Balance

Policy CodePolicy N/A

Change TypeRevised (operational clarifications)

Effective DateN/A

Next Review DateN/A

Key ActionProviders can view the Negative Balance Report via HPHConnect (Back Office role or higher) and direct inquiries to 800-708-4414 or AR_Negative_Balance@point32health.org.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

ALL of the following

ONE of
- Apply other claims payments as credits to offset the negative balance
- Transfer negative balance to other claims systems within Point32Health and its affiliates to offset the amount
- If not fully recovered through claims payments within 90 days, issue a refund request letter to the provider90 days
  Harvard Pilgrim issues a refund request letter if the negative balance is not fully recovered through other claims payments within 90 days.
- If negative balance cannot be recovered through other claims payments or a refund check, place uncollected funds in collection status
  Harvard Pilgrim reserves the right to place any uncollected funds in a collection status.

Access, Inquiries, and Collections

Note

Access and Inquiries — Negative Balance Report

The Negative Balance Report shows history of claims retracted/re-adjudicated that create a negative balance (amounts owed to Harvard Pilgrim), claims used to offset that negative balance, and any refund checks applied. Providers can view the Negative Balance Report through HPHConnect — access requires the Back Office user role or higher. If you do not have access, visit the HPHConnect registration page and follow the instructions for your organization type. For questions or to inquire about specific negative balance items, contact the Provider Service Center at 800-708-4414 or email AR_Negative_Balance@point32health.org.

Available in HPHConnect for users with claims access (Back Office role or higher)
Registration available via the HPHConnect registration page
Inquiries: Provider Service Center 800-708-4414; AR_Negative_Balance@point32health.org

Billing Rule

Recovery and Collections — Negative Balance Recovery

Harvard Pilgrim recovers negative balances by applying other claims payments as credits to offset the owed amount. If claims payments are insufficient, balances may be transferred within Point32Health and its affiliates to other claims systems for offset. If a negative balance is not fully recovered through claims payments within 90 days, Harvard Pilgrim will issue the provider a refund request letter. If recovery cannot be completed via offsets or refund check, Harvard Pilgrim reserves the right to place uncollected funds in collection status.

Recovery method: offset using other claims payments (credits)
Insufficient credits: transfer to other Point32Health/affiliate claims systems
90-day timeline: refund request letter issued if not fully recovered within 90 days
Unrecovered funds: may be placed in collection status

Key Definitions

Negative Balance — definition and reporting

DefinitionA dollar amount owed to Harvard Pilgrim reflected on the EOP summary page and in the PLB segment of the 835 file when a previously paid claim is retracted/re-adjudicated.

How it appears on EOPWhen a paid service is retracted on an EOP, the amount retracted becomes a negative or 'owed' dollar amount; activity is reported in the EOP summary box.

How it appears on 835Negative balance activity is reported in the Provider-Level Balance (PLB) segment of the 835 electronic remittance file.

Recovery via offsetsHarvard Pilgrim will recover negative dollar amounts by using other claims payments as credits to satisfy (offset/take back) the negative balance.

OpenPayer

Negative Balance

Retraction Causes and Recovery Actions

EDI Reporting and Recovery Period

Access, Inquiries, and Collections

Key Definitions