Noncovered Investigational Services MNG for Senior Products
Our newly developed MNG, effective April 1, 2025, details Noncovered Investigational Services for Tufts Medicare Preferred and Tufts Health Plan Senior Care Options (SCO).
Insights and Updates for Providers
February 2025
Initial inpatient admission notification requirement update
As of April 1, Point32Health must be notified within one business day following a member’s admission to an inpatient facility.
Important authorization reminders for Senior Products
Be sure to review these important reminders regarding new prior authorization requirements for Tufts Medicare Preferred and Tufts Health Plan Senior Care Options (SCO) members.
New substance use disorder treatment HEDIS tip sheet
Our new HEDIS® tip sheet offers insights and best practices related to the Initiation and Engagement of Substance Use Disorder Treatment (IET) measure.
Fee schedule updates in effect April 1
Updates to our Harvard Pilgrim Health Care Commercial professional fee schedules and our Point32Health behavioral health fee schedule will take effect on April 1, 2025.
CareLink claims runout
As part of Commercial integration, we no longer offer CareLink, and it’s important to submit any outstanding claims on or before Dec. 31, 2025.
Specialized Community Support Program Services 2025 updates
Learn more about the changes that MassHealth implemented the Community Support Programs for Homeless Individuals (CSP-HI) and Tenancy Preservation (CSP-TPP).
Archiving select Payment Policies
We’re archiving our Payment Reduction and Provider Payment Dispute Payment Policies for Tufts Health Plan, and the pertinent information is now available in our Provider Manuals.
Enrollment/screening for RI Medicaid providers
If you are a RI Medicaid provider who hasn’t yet completed screening and enrollment with the state Medicaid program, please do so to ensure continued participation in our Tufts Health RITogether network.
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 April 1, 2025.