Point32Health has updated our All-Inclusive Clinic Visit (HCPCS Code T1015) Payment Policy to reflect a billing and reimbursement change pertaining to Tufts Health Plan Senior Care Options (SCO) Medi (Medicaid-only) members only.
As a reminder, when billing for medically necessary all-inclusive clinic visits for Tufts Health Plan SCO Medi members, contracted federally qualified health centers and community centers should bill in accordance with the information noted in MassHealth Managed Care Entity Bulletin 84, to receive the higher Medicaid reimbursement rate.
Additionally, Point32Health is reprocessing claims from Jan. 1, 2022 onward that were not reimbursed in accordance with MassHealth Managed Care Entity Bulletin 84, for SCO Medicaid only members. Our systems have been appropriately aligned with the requirements outlined in the bulletin.
For more information, please refer to the updated All-Inclusive Clinic Visit (HCPCS Code T1015) Payment Policy. Also, we’re pleased to share that we’ve developed this quick reference guide to aid providers in distinguishing between Tufts Health Plan SCO Medi and SCO-SNP (dual eligible) members and verifying member eligibility.