Enrollment/screening for RI Medicaid providers
We would like to remind unscreened Rhode Island Medicaid providers to complete screening and enrollment with Rhode Island Medicaid as soon as possible.
Insights and Updates for Providers
July 2024
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.
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.
Reminder: required billing for telehealth services
Please keep required billing practices for telehealth services in mind.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
Enrollment/screening for RI Medicaid providers
Rhode Island Medicaid providers must complete Medicaid screening and enrollment.
MNG update: Non-Emergency Medical Transportation
Integrated Point32Health Medical Necessity Guidelines for Non-Emergency Medical Transportation.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
Adalimumab biosimilar strategy for RITogether
Adalimumab biosimilars have been added at preferred status to the formulary.
Reminder: trastuzumab biosimilar strategy
Reminder of our biosimilar strategy for trastuzumab oncology drugs.
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.
Enrollment/screening for RI Medicaid providers
Complete screening and enrollment to continue participating in Tufts Health RITogether.
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.
Adalimumab biosimilar strategy for RITogether
Adalimumab biosimilars added to the Tufts Health RITogether pharmacy formulary.
RI Medicaid screening deadlines
Complete Rhode Island Medicaid screening and enrollment prior to Feb. 1, 2024.
Ovia Health’s Family & Maternal Health Solutions
Ovia Health now available to Tufts Health Together and Tufts Health RITogether members.
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.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
Pharmacy program reminders
Coverage reminders related to our Pharmacy program.
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.
Enrollment/screening process for Medicaid providers
Providers who render services for Medicaid members must be screened by and enrolled with the appropriate state Medicaid agency.
New portal functionality for Tufts Health RITogether
For Tufts Health RITogether members, providers will soon have more electronic portal functionality than ever before.
Synagis coverage for the 2023-2024 RSV season
Point32Health would like to remind providers of our Synagis (palivizumab) policy for the 2023-2024 season.
Pharmacy coverage changes
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
Rhode Island professional fee schedule updates
Beginning Oct. 1, 2023, Point32Health will be updating the Rhode Island Medicaid professional fee schedule we use to determine claims reimbursement for services rendered to Tufts Health RITogether members.
Behavioral Health and substance use disorder tools and resources
Tufts Health RITogether providers have access to several behavioral health and substance use disorder resources. You’ll find information on behavioral health coverage, prior authorization and notification for behavioral health services, resources such as our Provider Manual, and more on the Tufts Health RITogether behavioral health webpage.
Claims filing requirement for court-ordered service
For RITogether members, Tufts Health Plan will not require prior authorization for claims for court-ordered mental health/substance abuse services, for dates of service beginning July 1, 2023.
Pharmacy coverage changes
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
Pharmacy coverage changes
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
Update for acute inpatient facility readmissions
Please be aware that for dates of service beginning Sept. 1, 2023, the readmission policies for DRG facilities for Tufts Health Direct, Tufts Health Together, and Tufts Health RITogether will be expanded to apply to providers reimbursed at a case rate.