Clarified billing reminder: ambulatory surgical center services
We’re offering a reminder and some additional clarification concerning correct coding practices to keep in mind when billing for ambulatory surgical center services.
Insights and Updates for Providers
April 2025
MassHealth coverage change for rapid-acting insulin products
Prior authorization is now required for Tufts Health Together members prescribed insulin Aspart, to encourage the use of cost-effective short-acting insulin agents.
Submission deadline for outstanding 2024 MassHealth claims
We’re reminding providers of MassHealth’s submission deadline for outstanding claims, claims corrections, and claims appeals for services provided between Jan. 1, 2024 and Dec. 31, 2024.
Updates to Inpatient Hospital Admissions Payment Policy
Point32Health is making updates to our Inpatient Hospital Admissions Payment Policy, effective for dates of service beginning June 1, 2025.
GLP-1 weight management medication coverage changes
Point32Health is making changes related to coverage of GLP-1 weight management medications, as part of our efforts to provide access to the most appropriate and efficacious health care options while managing health care costs.
Claims editing platform updates
In an effort to consistently apply industry standard claims edits reflecting national correct coding and guidelines from state regulatory agencies, we’re making updates to align our claims editing platforms.
Reducing drug wastage for outpatient chemotherapy drugs
We’re pleased to announce a new program aimed at reducing drug waste, in collaboration with OncoHealth, which conducts medical review of chemotherapeutic protocols for Harvard Pilgrim Commercial members.
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.
Announcing new integrated Point32Health payment policies
We have developed new integrated Point32Health Payment Policies pertaining to advanced practice providers, newborn care, and audiology, and will be archiving their respective legacy equivalents.
Audiology Payment Policy updated with new claim edits
We’re making some updates to our Audiology Payment Policy and associated billing and reimbursement practices, effective for dates of service beginning June 1, 2025.
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.
Prior authorization reminder: intensity-modulated radiation therapy
As a reminder, as of April 1 the previously announced continuity of care period has ended and a prior authorization must be obtained for all members starting IMRT prior to their course of treatment.
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.
Language interpretation services reminder
We’d like to remind our provider partners that Point32Health offers access to free language interpretation services to facilitate the care and treatment of your non-English-speaking patients.
Living Well Community – upcoming programs for providers and members
Our 2025 Living Well Community offers free wellness-related webinars and classes, and is continuing to expand its sessions to include webinars on nutrition, food choices, and more.