Content centralized to Point32Health provider website
We have finished consolidating content from our legacy websites onto the centralized Point32Health provider website for a more streamlined provider experience!
Insights and Updates for Providers
March 2025
Skilled nursing care: prior authorization update
We have amended a previous decision and prior authorization will not be required for skilled nursing care for Tufts Medicare Preferred members.
New medication adherence Star Measure tip sheet
Point32Health has developed a new Star Measure tip sheet for the Medication Adherence measure for patients prescribed medication for diabetes, hypertension, or cholesterol.
Commercial migration reminder: avoid duplicate claims
When submitting claims for members who have switched plans, please remember to submit claims to the health plan based on the member’s eligibility on the date of service.
Insourcing chronic kidney disease care management
Chronic kidney disease care management services for Tufts Health Direct members will be insourced within Point32Health’s integrated care management program.
Reminder: One Care training requirement
Providers and office staff are reminded to complete comprehensive training on the One Care program, available in the Training section of our website.
Members’ rights and responsibilities
Point32Health’s information on members’ rights and responsibilities is provided to clinicians at the time of member enrollment, and can be found in the Provider Manuals.
Coordinating care for medical and behavioral health
Point32Health encourages, and has resources to support, communication among medical and behavioral health care providers working with a shared patient to support whole-person care.
Pharmacy split fill program for select oral oncology drugs
Point32Health is implementing a pharmacy split fill program for select oncology drugs to improve medication adherence and reduce drug wastage.
Correct coding reminders
We’re offering reminders of correct coding practices when completing a UB-04 claim, and when billing for services ambulatory surgical 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, coverage updates, and more.
Pharmacy coverage changes
Please refer to this chart for information on updates to our Pharmacy coverage and Medical Necessity Guidelines.
MassHealth updates to Unified Formulary
MassHealth recently announced updates to the MassHealth Unified Formulary, which will take effect on May 12, 2025.