As we announced in previous issues of Insights and Updates for Providers, in January 2025 Point32Health began making updates to align our claims editing platforms for Tufts Medicare Preferred members.
In an effort to consistently apply industry standard claims edits reflecting national correct coding and guidelines from state regulatory agencies, we will apply similar updates for claims with dates of service on or after June 1, 2025 for members of our Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, and Tufts Health Plan Senior Care Options (SCO) Medi (Medicaid-only) plans. (The updates will not apply to SCO-SNP (dual eligible) members. Refer to this quick reference guide for help distinguishing between SCO Medi and SCO-SNP members.)
For this effort we’ll be leveraging existing tools, and you’ll continue to submit claims the same way you do today. This work is part of our ongoing commitment to ensuring accurate claims processing and consistency with correct coding standards.