Join the Tufts Health Plan network - Point32Health Provider

In 2021, Harvard Pilgrim Health Care, Tufts Health Plan and our family of companies combined to create Point32Health, a leading not-for-profit health and well-being organization, delivering a better health care experience to our members and the communities we serve. Become a participating provider today, and together we we improve health outcomes and the value of health care, through true collaboration in tackling today’s health care challenges.

To join the network, please complete and submit the materials as noted below. For status inquires on your application, please contact us at [email protected].

Medical Professional Providers

For providers such as MDs, DOs, DPMs and oral surgeons. If you participate in a Physician Organization (such as an IPA or PHO), prior to completing the above paperwork, contact the Provider Unit or Contracting administrator of your organization to discuss next steps.

HCAS Provider Enrollment Form for Commerical or Senior Products
Provider Information Data Form for Public Plans products
W-9

Submit completed materials by email to [email protected].

Ancillary Providers

Includes Ambulance, ASC, DME, Home Care, Infusion Centers, Labs, Radiology, SNFs, and Urgent Care.

Submit completed materials by email to [email protected].

Behavioral Health

Submit completed materials by email to [email protected].

New to this process?

New to this process? Refer to our “Becoming a network provider” tip sheet to learn about the steps involved, including contracting, credentialing, and enrollment, as well as information on maintaining your CAQH profile and affiliation changes.

View the tip sheet

Credentialing is your next step

For all providers, credentialing is an important step in being able to provide care to our members. Refer to the credentialing information below and begin with CAQH ProView.

Get started at CAQH ProView

Once you are a participating provider, our Welcome Flyer will guide you through getting started with us. Learn how to register for our secure portals, sign up for our monthly electronic newsletter, register for electronic funds transfer and more.
View our welcome flyer

Credentialing and other important reminders

Contract completion

We will return a contract to you for review. The contract should be reviewed, signed and sent back to us to initiate credentialing.
Once the contract is finalized and you are approved as a participating provider, we will send you a welcome letter that includes your network participation effective date and useful resources.
Generally, credentialing and contracting can take 1-2 months. However, that time frame is extended if the application is incomplete.

Credentialing

Point32Health credentials affiliated providers when they join the network. Clinicians cannot provide services for members until the credentialing committee approves them for network participation.
Credentialing occurs once the provider has a signed agreement with the Plan. The Credentialing team cannot proces the application until all required materials are received. You will be notified by email if the application cannot be processed due to incomplete information.
Applicant requesting an initial affiliation with Point32Health will be credentialed through the HCAS process, utilizing CAQH’s ProView system, a central repository for credentialing information. Data from CAQH ProView will only be transmitted to plans with which clinicians are already contracted or are in the process of contracting. For more information about HCAS and its credentialing process, go to www.hcasma.org.
Get started by visiting CAQH ProView.

Medicaid requirements

Federal regulations require that providers who render services to Medicaid members are screened by and enrolled with the appropriate state Medicaid agency. This requirement applies to providers who participate in Tufts Health RITogether or Tufts Health Together – MassHealth MCO Plan and Accountable Care Partnership Plans (ACPPs).

Tufts Health RITogether: Complete this screening and enrollment process via the Rhode Island Executive Office of Health and Human Services (EOHHS) provider portal.
Tufts Health Together: Complete this screening and enrollment process via the MassHealth website. For more information, refer to this FAQ.

Resources and welcome materials