New Point32Health webpages to streamline your operations
We are announcing a few integrated webpages to streamline the provider experience, including our Prior Authorization, Forms, and Vendor Programs pages.
Insights and Updates for Providers
October 2024
Electronic corrected claims reminder
As a reminder, corrected claims submissions should not include documentation of previous payment information, as this may delay processing.
Synagis coverage for the 2024-2025 RSV season
We would like to remind providers that Synagis requires prior authorization, and how to request authorization for the 2024-2025 season.
Payment Policy update and modifier requirements
We’re introducing a streamlined Point32Health Drugs and Biologicals Payment Policy and will require providers to append modifier JW or JZ, when applicable.
Coverage update for mental health wellness examinations
Mental health wellness examinations will now be covered annually at no cost to Tufts Health Together members, effective retroactively beginning July 1, 2024.
Psychotherapy services billing reminder
When billing for psychotherapy services, use the procedure code that most closely reflects the duration of time spent with the patient during the session.
Pharmacy coverage changes
We have made updates to our pharmacy program; please refer to the Pharmacy Medical Necessity Guidelines page on our website for more details.
Prior authorization required for noninvasive prenatal testing
Point32Health requires prior authorization for coverage of all prenatal testing, including NIPT, which can be requested using the resources provided here.
Behavioral health service navigation program for members
We recently launched our behavioral health service navigation program to provide personalized guidance for patients seeking information regarding telebehavioral health care.
Pharmacy coverage changes
We have made updates to our pharmacy program; please refer to the Pharmacy Medical Necessity Guidelines page on our website for more details.
Change Healthcare update: Timely filing limits and claim adjustment requirements to resume
Point32Health will return to our standard requirements for all lines of business regarding timely filing and claim adjustments, effective Sept. 1, 2024.
Recovering negative balances
We have outlined reasons why a claim may be retracted, resulting in a negative balance, and ways to resolve a negative balance.
Reminder: removal of certain prior authorization requirements
We would like to remind our providers of certain procedures and associated codes that no longer require prior authorization.
Coverage reminder – Community Behavioral Health Center services
We would like to remind providers of notification requirements and billing procedures related to Community Behavioral Health Center services.
Pharmacy coverage changes
We have made updates to our pharmacy program; please refer to the Pharmacy Medical Necessity Guidelines page on our website for more details.
Removal of prior authorization requirements for certain procedures
We are removing prior authorization requirements from certain procedures and associated codes in a continued effort to administratively simplify providers’ experience.
Pharmacy coverage changes
Read about updates to Point32Health’s Pharmacy program and our Pharmacy Medical Necessity Guidelines for Harvard Pilgrim and Tufts Health Plan.
Telehealth reimbursement update for BH services
Increased reimburse rate for BH telehealth services provided by non-BH providers.
Reminder: required billing for telehealth services
Please keep required billing practices for telehealth services in mind.
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.
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.
Provider data, enrollment, and credentialing email address
We’re consolidating email addresses for submission of information to Tufts Health Plan.
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.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
Expanded access to CGP for advanced solid tumors
We’re reminding providers of our comprehensive genomic profiling coverage and authorization process.
Use code A4287 for coverage of breast milk storage bags
Use code A4287, not K1005, for coverage of breast milk storage bags.
Point32Health non-emergent ambulance reimbursement
Integrated Point32Health Ambulance and Transportation Services Payment Policy and reimbursement update.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
Reminder: Psychological testing and TMS
Attach Psychological and Neuropsychological Assessment and/or rTMS form(s) to prior authorization requests.
Pharmacy program reminders
Point32Health would like to offer some reminders pertaining to our Pharmacy program.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
Crisis resource reminder for Massachusetts members
Learn more about Community Behavioral Health Center resources available in Massachusetts.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
Pharmacy program reminders
Coverage reminders related to our Pharmacy program.
Urine Drug Testing Payment Policy integration
Urine Drug Testing coverage and payment policy updates.
New ICD-10 code for HIV PrEP
HIV PrEP billing requirements and new ICD-10 code.
Pharmacy coverage changes
Jan. 1, 2024 Pharmacy coverage changes for various Point32Health products.
Preferred oncology biosimilars for 2024
Preferred products for the bevacizumab, rituximab, and trastuzumab drug classes.
Other 2024 Pharmacy program updates
2024 Pharmacy updates: Harvard Pilgrim commercial, Tufts commercial, Tufts Health Direct.
Complex Care Management services
Point32Health provides care management services for adult and pediatric members.
About Our Chronic Condition Management Programs
Point32Health’s approach to chronic condition management through patient-centered care.