Telehealth reimbursement update for BH services
Increased reimburse rate for BH telehealth services provided by non-BH providers.
Insights and Updates for Providers
February 2025
Reminder: Value codes required on ESRD claims
Required value codes when billing for end-stage renal disease services.
Reminder: required billing for telehealth services
Please keep required billing practices for telehealth services in mind.
GIC product updates effective July 1
The 2024-2025 plan year for Harvard Pilgrim/GIC products begins July 1.
Reimbursement update: Behavioral Health Integration services
Point32Health is expanding coverage for Behavioral Health Integration services.
New HEDIS tip sheet for Prenatal Immunization Status
We’ve developed a new HEDIS® tip sheet for the PRS-E measure.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
Updates to medical drug claims editing logic
We’re updating medical drug claims editing logic to remove certain edits.
Utilization management update for home health care services
We’re updating home health care UM requirements for quality and efficiency.
MNG update: Non-Emergency Medical Transportation
Integrated Point32Health Medical Necessity Guidelines for Non-Emergency Medical Transportation.
Standard form for Applied Behavior Analysis prior authorization requests
A standard authorization form for ABA services has been adopted.
Complex Care Management services
Point32Health provides complex care management services individually tailored to patients.
About Our Chronic Condition Management programs
Point32Health’s chronic condition management programs reinforce clinician treatment plans.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
Reminder: trastuzumab biosimilar strategy
Reminder of our biosimilar strategy for trastuzumab oncology drugs.
Oral formula authorization request update
Clarification on how to request authorization for oral formula.
Reminder: Step therapy protocols and exceptions
Massachusetts law now requires mandatory exceptions in step therapy protocols.
Coverage update for mental health wellness examinations
Annual mental health wellness exams covered at no cost for certain members.
Billing for lead screening
Lead screenings for ages 0-6 years covered with no member cost share.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.