Our contact information
We want to highlight some key contact information and resources for providers contacting us for support, such as our online provider portals and Provider Services team.
Insights and Updates for Providers
January 2025
New Payment Policy and billing for hospital at home
Point32Health has developed a Payment Policy for Inpatient Hospital Admissions, which includes billing instructions for hospital at home care, which Point32Health reimburses for contracted providers when medically necessary.
HEDIS MY2024 medical record requests
As required by NCQA and CMS, Point32Health will send HEDIS MY2024 medical record requests via mail to providers for all Point32Health products beginning in February 2025.
Living Well – 2025 program offerings for providers and members
We’re pleased to announce enhancements to our virtual Living Well program for the year ahead, including webinar series on a number of fascinating topics.
CAQH Provider Data Portal updates and upcoming training
If you utilize the CAQH Provider Data Portal to review and update your provider directory information, you’ll soon see some additional required fields.
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.
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.
Prior authorization update for administration of CAR T-cell drugs
In response to provider feedback, we will no longer require prior authorization for the preparation and administration of the following CAR T-cell therapy medications.
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.
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.
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.
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.
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.
Point32Health Medical Necessity Guideline updates
Providers and office staff can refer to the following chart to review changes and updates to Point32Health’s Medical Necessity Guidelines.
Point32Health medical drug program updates
Providers and office staff can refer to the following chart to review updates to our medical benefit drug program.
Point32Health Vaccines and Immunizations Payment Policy
We have developed an integrated Point32Health Vaccines and Immunizations Payment Policy and archived the previous legacy Harvard Pilgrim Health Care and Tufts Health Plan policies.
New 2025 CPT and HCPCS codes
Point32Health will update systems and policies to reflect new 2025 CPT and HCPCS codes beginning Jan. 1, 2025.
Important updates on reaching us by phone, email, and fax
We are providing a reminder on how to reach us for certain transactions, including a new fax number, along with resource guides for our secure portals.
Point32Health Obstetrics and Gynecology Payment Policy
Our new integrated Point32Health Obstetrics and Gynecology Payment Policy will replace our previous Harvard Pilgrim and Tufts Health Plan policies.
Point32Health Medical Necessity Guideline updates
Providers and their office staff can refer to this chart to review changes and updates to the Point32Health Medical Necessity Guidelines.
Point32Health medical drug program updates
Providers and their office staff can review the following chart for changes and updates to our coverage program for medical drugs.
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.
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.
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.
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.
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.
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.
Provider Service Center email update
We encourage providers to use electronic options for a variety of transactions, as the Provider Service Center will be discontinuing its email account.
Administrative termination of inactive providers
We annually review our provider network and may terminate providers who have not provided services to our members in the past two years.
Reminder: Correct coding and claims edits
To ensure accurate claims processing, claims submitted to Point32Health are subject to regular edits based on regulatory guidelines, medical society recommendations, and more.
Psychiatric Collaborative Model of Care billing reminder
When billing our members for services delivered through the Psychiatric Collaborative Model of Care, it’s important to use the procedure codes identified here.
Correct coding edits effective Oct. 1, 2024
To align with industry standard coding practices, Point32Health is making updates to our General Coding and Claims Editing Payment Policy.
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.
New maternity and family planning webpages launch
We’ve launched maternity sections of our Point32Health and Harvard Pilgrim member websites for those in all stages of family planning and care.
New HEDIS tip sheet for GSD
We’ve developed a new HEDIS tip sheet related to the Glycemic Status Assessment for Patients with Diabetes measure, highlighting best practices to support your practice.
Contracting, Enrollment, and Credentialing Quick Reference Guide
This quick reference guide highlights differences among the contracting, enrollment, and credentialing processes required to become a network provider.
Dr. Jud Brewer’s Hunger Habit workshop available on demand
Access the recorded version of Dr. Jud Brewer’s Hunger Habit workshop on the Boston University Center for Continuing Education website until April 22, 2025.
Help us keep directory information up to date
Providers must review and revalidate their information every 90 days to ensure accuracy of our Provider Directory, and notify Point32Health in advance of any changes.
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 and coverage, updated MNGs, and more.