Change Healthcare update: Timely filing limits and claim adjustment requirements to resume
Point32Health will return to our standard requirements for all lines of business regarding timely filing and claim adjustments, effective Sept. 1, 2024.
Insights and Updates for Providers
July 2024
Recovering negative balances
We have outlined reasons why a claim may be retracted, resulting in a negative balance, and ways to resolve a negative balance.
ConnectorCare plans – in-network coverage reminder
Harvard Pilgrim has joined Tufts Health Plan as a ConnectorCare issuer for 2024, expanding access to affordable health care coverage for thousands of Massachusetts residents.
Enrollment/screening for RI Medicaid providers
We would like to remind unscreened Rhode Island Medicaid providers to complete screening and enrollment with Rhode Island Medicaid as soon as possible.
Reminder: removal of certain prior authorization requirements
We would like to remind our providers of certain procedures and associated codes that no longer require prior authorization.
New maternity and family planning webpages launch
We’ve launched maternity sections of our Point32Health and Harvard Pilgrim member websites for those in all stages of family planning and care.
New HEDIS tip sheet for GSD
We’ve developed a new HEDIS tip sheet related to the Glycemic Status Assessment for Patients with Diabetes measure, highlighting best practices to support your practice.
Contracting, Enrollment, and Credentialing Quick Reference Guide
This quick reference guide highlights differences among the contracting, enrollment, and credentialing processes required to become a network provider.
MassHealth update to reimbursement for certain 340B drugs
Effective July 1, 2024, Point32Health will no longer provide reimbursement for certain drugs for Tufts Health Together members when purchased through the 340B program.
Dr. Jud Brewer’s Hunger Habit workshop available on demand
Access the recorded version of Dr. Jud Brewer’s Hunger Habit workshop on the Boston University Center for Continuing Education website until April 22, 2025.
Help us keep directory information up to date
Providers must review and revalidate their information every 90 days to ensure accuracy of our Provider Directory, and notify Point32Health in advance of any changes.
Coverage reminder – Community Behavioral Health Center services
We would like to remind providers of notification requirements and billing procedures related to Community Behavioral Health Center services.
Point32Health Medical Necessity Guideline updates
Refer to this chart to review changes and updates to Point32health’s Medical Necessity Guidelines, information about newly developed MNGs, and more.
Point32Health medical drug program updates
Refer to this chart to review changes and updates to Point32Health’s medical drug program, including information about prior authorization and coverage, updated MNGs, and more.
Pharmacy coverage changes
We have made updates to our pharmacy program; please refer to the Pharmacy Medical Necessity Guidelines page on our website for more details.
Upcoming training opportunities
We invite you to register for one of our many interactive training sessions during the month of July.