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Health Plans, Inc. (HPI) is a Third Party Administrator (TPA) of health insurance plans. Patients presenting cards like the samples linked below have a plan administered by HPI. That means we administer all the eligibility and claim processing for the Plan.
We partner with multiple provider networks, including United Healthcare, Cigna, EHN and Prime Health Services to give the patient the best access to care in their area. You might see other logos on the card for other payers as well. When you see an ID card with our logo and that of another payer or network, it means they are our provider network partner for that plan package.
Visit our About Us section to learn more about our history and the other services we administer.
Every provider operating system is different, so our Plan may not be found the same way in each system. To locate us in your electronic medical record/electronic health record system, you should try one of the following searches depending on what you see on the card:
Some Systems let you search by PO Box or Zip Code as well. If your system allows that type of search, try these:
PO Box: 5199
Zip code: 01581
If you can't find HPI in your system, visit our Provider Resources page to learn about how to confirm benefits and eligibility online.
Learn about the HPI Member ID Card and how to read it here:
Need to submit a claim? Review the claim submission address or electronic payor ID # on the back of the patient’s member ID card.
For most members, claims can be mailed or submitted electronically to us at the address or payer ID's below; however, the address and payer ID's may vary based on member-specific plans and networks.
Health Plans, Inc.
PO Box 5199
Westborough, MA 01581
You can also submit your claims electronically using HPHC payer ID # 04271 or
WebMD payer ID # 44273.
Our Plans administered for employer groups based outside of New England do not typically require referrals to specialty care.
Prior Authorization requirements vary by plan. Please review the patient’s benefits online by clicking here or contact the Provider Services phone number listed on the back of the member’s ID card for more information.
As you know, on April 17, Point32Health, the parent organization of Harvard Pilgrim Health Care and Tufts Health Plan, identified a cybersecurity incident that impacted systems we use to service members, accounts, brokers, and providers. The affected systems supported Harvard Pilgrim Health Care’s commercial accounts, Medicare Advantage Stride℠ HMO-POS, and HPI claims repricing. For more information on the incident, click here.
While taking the necessary steps to address the incident, Point32Health held many claims for HPI patients from processing. Point32Health is now steadily releasing these claims to HPI for processing.
HPI received an influx of original and duplicate claims we are working to process through the system. We are processing claims diligently and continuously, but it will take some time to work through the backlog. We expect to have completed processing delayed claims in the coming weeks.
Important: If you have already submitted your claims, but they are not yet in the system, they may be on files not yet loaded. Please do not submit duplicates, as this will only increase the delay in processing.
Thank you for your continued patience and partnership as we work through this challenging situation.
© 2023 Health Plans, Inc.
Health Plans, Inc. is a Harvard Pilgrim company