New content on Point32Health provider website
In support of our ongoing efforts to continually improve and simplify your engagement with us, we’re thrilled to announce that we’ve developed four additional Point32Health provider pages.
Insights and Updates for Providers
December 2024
Portal, phone, and fax update for referrals, notifications and authorizations
In recent issues, we announced some updates on reaching us by phone, email, and fax, and are providing the following clarifications and reminders.
New HEDIS tip sheets for SPC and FMC measures
We’re pleased to introduce HEDIS® tip sheets for Statin Therapy for Patients with Cardiovascular Disease and Follow Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions.
Clinical practice guidelines updates
Point32Health maintains a number of clinical practice guidelines, which you can find on the Clinical Practice Guidelines section of our provider website, and we have recently updated some.
Reminder: Update on our behavioral health network
With our robust, insourced behavioral health network now firmly established, effective Jan. 1, 2025, non-contracted Harvard Pilgrim providers will no longer be considered in network.
Claims denial process update for Maine
Consistent with new Maine regulation, we will no longer deny claims from network providers for failure to obtain prior authorization.
New pilot program offers in-home health evaluations
Tufts Health Together is offering a pilot program to provide in-home and virtual health evaluations to patients, in collaboration with Signify Health.
Orphan Drug Program launch
Point32Health is collaborating with OptumRx, our pharmacy benefit manager, to introduce a new Orphan Drug Program, available Jan. 1, 2025.
Reminder: QMB members exempt from Part A/B cost-sharing
As a reminder, providers are prohibited from charging QMB members for Medicare cost-sharing for covered Part A/B services.
Point32Health’s access to care standards
Our applicable access to care/practice site standards policies outline network practitioner standards regarding clinician availability, timeliness of appointments, and telephone accessibility, among other things.
Billing for behavioral health boarding
We’ve clarified the billing requirements outlined in our payment policies pertaining to BH boarding, and have updated a BH boarding billing requirement for Tufts Health Direct.
Submit corrected claims electronically for timely processing
We encourage our provider network to submit corrected claims electronically for Senior Products members for expedited claims processing.
Point32Health Medical Necessity Guideline updates
Providers can refer to the following chart to review updates and changes to our Medical Necessity Guidelines.
Point32Health medical drug program updates
Providers can refer to the following chart to review updates and changes to our medical benefit drug program.
MassHealth updates to Unified Formulary
Providers should be aware that MassHealth announced updates to the MassHealth Unified Formulary, which will take effect on Feb. 18, 2025.
Modifiers and reminders for home infusion therapy
We’re offering some reminders regarding the reporting of home infusion therapy services. Additionally, as of Feb. 1, 2025, please include modifier SH or SJ as appropriate.