Change Healthcare update: Claims submission connectivity available for all products
All products now have restored electronic claims submission connectivity with Change Healthcare.
Insights and Updates for Providers
May 2024
Bill capped rental modifiers as appropriate
Bill capped rental DME items with the appropriate capped rental modifier.
Telehealth reimbursement update for BH services
Increased reimburse rate for BH telehealth services provided by non-BH providers.
Reminder: Value codes required on ESRD claims
Required value codes when billing for end-stage renal disease services.
Reminder: required billing for telehealth services
Please keep required billing practices for telehealth services in mind.
GIC product updates effective July 1
The 2024-2025 plan year for Harvard Pilgrim/GIC products begins July 1.
BH Performance Specifications now on the Point32Health website
Behavioral Health performance specifications now on Point32Health’s provider website.
Reimbursement update: Behavioral Health Integration services
Point32Health is expanding coverage for Behavioral Health Integration services.
New HEDIS tip sheet for Prenatal Immunization Status
We’ve developed a new HEDIS® tip sheet for the PRS-E measure.
Depression screening in the primary care setting
Please conduct depression screening during routine medical office visits.
Coordination of medical and behavioral health care
Collaboration between PCPs and BH providers for high quality patient care.
Join us for Dr. Amishi Jha’s Peak Mind webinar!
Join us for Dr. Amishi Jha’s Peak Mind webinar!
Point32Health’s access to care standards
Access to care policies for Tufts Health Plan and Harvard Pilgrim.
Point32Health Medical Necessity Guideline updates
Read more to review updates to Point32Health Medical Necessity Guidelines.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
MassHealth updates to Unified Formulary
MassHealth recently announced the following updates to their Unified Formulary.
Upcoming training opportunities
We’re offering several interactive webinars throughout the month of March.