Provider Service Center email update
We encourage providers to use electronic options for a variety of transactions, as the Provider Service Center will be discontinuing its email account.
Insights and Updates for Providers
August 2024
Reminder on home infusion administration
Authorization is not required for the administration of home infusion drugs; however, it is still required for the home infusion drugs themselves.
Administrative termination of inactive providers
We annually review our provider network and may terminate providers who have not provided services to our members in the past two years.
Reminder: Correct coding and claims edits
To ensure accurate claims processing, claims submitted to Point32Health are subject to regular edits based on regulatory guidelines, medical society recommendations, and more.
SCO Home- and Community-Based Services Payment Policy
We’ve developed a payment policy for home- and community-based services for Tufts Health Plan Senior Care Options, effective Oct. 1, 2024.
Claims editing platform updates
We’re making updates to our claims editing platforms, effective Oct. 1, 2024 for our Tufts Medicare Preferred members.
Prior authorization required for noninvasive prenatal testing
Point32Health requires prior authorization for coverage of all prenatal testing, including NIPT, which can be requested using the resources provided here.
Psychiatric Collaborative Model of Care billing reminder
When billing our members for services delivered through the Psychiatric Collaborative Model of Care, it’s important to use the procedure codes identified here.
Behavioral Health and substance use disorder tools and resources
Tufts Health RITogether behavioral health providers can use the resources listed to work with us and support patients with behavioral health care.
Behavioral health service navigation program for members
We recently launched our behavioral health service navigation program to provide personalized guidance for patients seeking information regarding telebehavioral health care.
Reminder when updating portal access for users
The Tufts Health secure portal allows administrators to manage users and permissions, and our online portal guide offers step-by-step instructions for routine actions.
Correct coding edits effective Oct. 1, 2024
To align with industry standard coding practices, Point32Health is making updates to our General Coding and Claims Editing Payment Policy.
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
We have made updates to our pharmacy program; please refer to the Pharmacy Medical Necessity Guidelines page on our website for more details.
MassHealth updates to Unified Formulary
MassHealth recently announced updates to the MassHealth Unified Formulary, effective Oct. 1, 2024, which will apply for Tufts Health Together.