Point32Health is updating our rules and requirements associated with appeals submission and timely filing limits for Tufts Health Public Plans claims, consistent with MassHealth guidelines, effective for dates of service beginning Jan. 1, 2025.
Maximum limit on appeals
In alignment with the current policy for our Harvard Pilgrim Health Care and Tufts Health Plan Commercial plans, as of Jan. 1, Tufts Health Public Plans will enforce a maximum limit of two levels of appeals. Additional appeals will be denied.
Appeals and timely filing denials
Additionally, as you may know, for Tufts Health Public Plans, claims for professional or outpatient services must be received within 90 days of the date of service, or within 90 days of the date of hospital discharge for inpatient or institutional services. Any claims received after this window are denied for timely filing. As of Jan. 1, 2025, Tufts Health Public Plans will not review or consider appeals submitted for claims denied for exceeding the timely filing limit — unless they meet one of the exception criteria outlined by MassHealth. The Claim Requirements, Coordination of Benefits and Dispute Guidelines section of our Tufts Health Public Plans Provider Manual will be updated in advance of the Jan. 1, 2025 effective date to reflect the changes outlined in this article, including any exceptions.
If a claim that does not meet one of these exceptions is denied for timely filing, there will be no option to appeal and the denial will stand.