Important updates on reaching us by phone, email, and fax
We’re modifying the way we accept requests for authorizations, notifications, and referrals across Point32Health, and recommend electronic and fax options for greater efficiency.
Insights and Updates for Providers
September 2024
ChoiceNet and Focus Network – MA 2025
Tier assignments for Harvard Pilgrim’s ChoiceNet HMO and PPO plans, determined based on quality and cost performance, take effect January 1, 2025.
InstED in-home urgent care pilot expands availability
We are expanding our instED program to members in Bristol, Plymouth, Hampshire, and Hampden counties in MA, and Hillsborough and Rockingham counties in NH.
Payment Policy update and modifier requirements
We’re introducing a streamlined Point32Health Drugs and Biologicals Payment Policy and will require providers to append modifier JW or JZ, when applicable.
Claims edits for Harvard Pilgrim Commercial plans
Effective Nov. 1, 2024 we will apply certain edits for our Harvard Pilgrim Commercial plans that are currently in place for Tufts Health Plan.
New HEDIS tip sheet for osteoporosis measure
Point32Health has highlighted best practices in a new HEDIS® tip sheet for the Osteoporosis Management in Women Who Had a Fracture (OMW) measure.
Learn how to get the most out of every moment!
Join us on Wednesdays in September for our upcoming Living Well webinar series: Healthy Habits to Get the Most Out of Every Moment.
Harvard Pilgrim Provider Portal required fields update
Harvard Pilgrim is making an update to the electronic prior authorization request submission in HPHConnect when submitting an outpatient service transaction, effective Nov. 1, 2024.
Help us keep directory information up to date
Please review and revalidate your practice information every 90 days to ensure accuracy of our Provider Directory, and notify Point32Health in advance of any changes.
Metabolic Monitoring for patients on antipsychotic medications
Help ensure patients taking antipsychotic medications receive annual screenings by ordering in-office point of care HbA1c or fasting glucose tests for diabetes and monitoring cholesterol.
The importance of culturally appropriate health care
Point32Health provides interpretation services for hundreds of languages, along with cultural competency training opportunities, to ensure providers are mindful of patients’ cultural and linguistic needs.
Coordinating care for medical and behavioral health
Point32Health offers many resources, including our Coordination of Care Check List, for providers with patients living with chronic physical and/or mental illness.
Promoting the flu vaccine
September and October are good times to vaccinate against the flu, and providers play a vital role in keeping patients informed to make healthy decisions.
New 2024 Model of Care Training available
We encourage Tufts Health Plan SCO PCPs and specialists to complete the new 2024 SCO Model of Care training by December 31, 2024.
Coverage update for mental health wellness examinations
Mental health wellness examinations will now be covered annually at no cost to Tufts Health Together members, effective retroactively beginning July 1, 2024.
Psychotherapy services billing reminder
When billing for psychotherapy services, use the procedure code that most closely reflects the duration of time spent with the patient during the session.
Reducing 30-day readmissions
Timely follow-up and patient education are key to ensuring effective transition of care interventions and preventing hospital readmissions within 30 days.
RI Medicaid screening and prohibition of balance billing
Rhode Island Medicaid providers are required to complete screening and enrollment with Medicaid to receive payment for services for our Tufts Health RITogether members.
Billing charges on claims for same date of service
When billing for an office visit with more than one service, providers should report all service codes related to the visit on one claim.
Capped rental modifiers: reminder and clarification
Capped rental durable medical equipment should be billed with the appropriate capped rental modifier, in accordance with correct coding practices, to ensure reimbursement.
HEDIS strategies: behavioral health and substance use
We are providing reminders and strategies for improvement on the FUH and IET HEDIS measures to maximize the opportunity for success.
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.
MassHealth updates to Unified Formulary
MassHealth recently announced updates to the MassHealth Unified Formulary, effective Nov. 1, 2024, which will apply for Tufts Health Together.
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.