Point32Health is updating our requirements related to notification of initial inpatient admissions for members of our Tufts Medicare Preferred, Tufts Health Plan Senior Care Options, Tufts Health Together, Tufts Health RITogether, and Tufts Health One Care plans, effective for dates of service beginning April 1, 2025.
As of that date, Point32Health must be notified within one business day following a member’s initial admission to an inpatient facility — this is a change from the current policy, which requires that notification be submitted within two business days.
This change is intended to better support utilization management physicians in discharge planning and care coordination efforts and further our common goal of ensuring that our members receive the best care for them in the right setting, at the right time.
Our relevant Payment Policies have been updated to reflect this change, and the Tufts Health Plan Senior Products and Tufts Health Public Plans Provider Manuals will be updated in alignment with the April 1 effective date. In addition, on April 1 our Tufts Health Plan Referral, Prior Authorization, and Notification Payment Policy and Avoiding Administrative Claim Denials Payment Policy will be retired, and any pertinent information from these policies will be reflected in our applicable Provider Manuals and prior authorization resources.