Ensuring uninterrupted care for members — especially those in active treatment or managing chronic conditions — is an integral component of Point32Health’s mission. In the spirit of that commitment, we’re pleased to share that beginning Jan. 1, 2026, we will honor existing prior authorizations from in-network providers when a patient switches to a Harvard Pilgrim Health Care Commercial plan or Tufts Health Direct from another insurer.

This important continuity of care initiative aligns with AHIP’s efforts to streamline prior authorization and will serve to connect patients more quickly to care while reducing administrative burden for providers. 

Below we’ve outlined the information you’ll need to know about the scope of the change, how to submit the required proof of authorization, and other key details. 

Honoring existing authorizations 

If a member has a prior authorization in place from an in-network provider under their previous insurer, we will honor that authorization for 90 days after their new plan’s effective date. During this 90-day continuity of care period, no additional medical necessity review will be required. Keep in mind, however, that services authorized by a previous insurer from an out-of-network provider will continue to be subject to additional medical necessity review. 

This applies to benefit-equivalent medical and behavioral health services, as well as pharmacy drugs and items. (Please note that medical drugs are not in scope for this change and will require a new prior authorization.) 

How to submit proof of authorization 

To continue medical and behavioral health services without interruption, providers will need to validate that the member had an active authorization on file with their previous insurer by submitting a copy of the authorization letter. Alternatively, you can submit the following documentation: 

  • Previous provider information
  • Dates of service
  • CPT codes
  • Number of units or visits authorized
  • Authorization number from the previous plan

For medical services, this information should be submitted by fax to:

  • Harvard Pilgrim Health Care - 800-232-0816
  • Tuft Health Direct - 888-415-9055

Please fax proof of authorization for behavioral health services to: 

  • Harvard Pilgrim Health Care - 800-232-0816
  • Tuft Health Direct - 888-977-0776

For pharmacy drugs, if an active authorization existed under the member’s previous plan, providers are not required to submit proof of prior authorization. To request a 30-day prescription extension, you can call the appropriate Harvard Pilgrim Health Care or Tufts Health Plan Provider Service Center.

For medical and behavioral health services as well as pharmacy drugs and items, once prior authorization is verified, Point32Health will enter the information into our system to allow for extended coverage for 90 days from the member’s Harvard Pilgrim Commercial or Tufts Health Direct plan start date.

Vendor programs 

In cases where Point32Health utilizes a contracted vendor to oversee utilization management for certain services, if an active authorization existed under the member’s previous plan, providers are not required to submit proof of prior authorization to Point32Health. However, requirements for documentation may vary by vendor. You can find information about these vendors on the Vendor programs page on the Point32Health provider website. Refer to a respective vendor’s website or call the phone number provided for information on prior authorization and continuity of care.

More information 

We’ve updated the prior authorization sections of the Harvard Pilgrim Health Care Commercial and Tufts Health Public Plans Provider Manuals to reflect this change. For any questions you may have, contact the applicable Provider Service Center.

*Editor's note: formatting of fax information updated for submitting proof of authorization for medical and behavioral health services.