Join the Tufts Health Plan network

In 2021, Tufts Health Plan and Harvard Pilgrim Health Care combined to create Point32Health, a leading not-for-profit health and well-being organization. Become a participating provider today, and together we we improve health outcomes and the value of health care, through true collaboration in tackling today’s health care challenges.

To join the network, please complete and submit the materials as noted below. For status inquires on your application, please contact us at [email protected].

 

Medical Professional Providers

For providers such as MDs, DOs, DPMs and oral surgeons. If you participate in a Physician Organization (such as an IPA or PHO), prior to completing the above paperwork, contact the Provider Unit or Contracting administrator of your organization to discuss next steps.  

Submit completed materials by email to [email protected].

 

Ancillary Providers

Includes Ambulance, ASC, DME, Home Care, Infusion Centers, Labs, Radiology, SNFs, and Urgent Care.

Submit completed materials by email to [email protected].

 

 Behavioral Health

Submit completed materials by email to [email protected].

Understanding contracting and enrollment 

Refer to our “Becoming a network provider” tip sheet to learn about contracting, credentialing, and enrollment, and maintaining your CAQH profile. View the tip sheet

Start with our Welcome Flyer

Once you are a participating provider, our Welcome Flyer will guide you through getting started with us, including registering for our secure portals, EFT, and our provider newsletter. View our Welcome Flyer

Credentialing is your next step 

For all providers, credentialing is an important step in being able to provide care to our members. Refer to the credentialing information below and begin with CAQH ProView. Get started at CAQH ProView

  • We will return a contract to you for review. The contract should be reviewed, signed and sent back to us to initiate credentialing.
  • Once the contract is finalized and you are approved as a participating provider, we will send you a welcome letter that includes your network participation effective date and useful resources.
  • Generally, credentialing and contracting can take 1-2 months. However, that time frame is extended if the application is incomplete.
  • Point32Health credentials affiliated providers when they join the network. Clinicians cannot provide services for members until the credentialing committee approves them for network participation.
  • Credentialing occurs once the provider has a signed agreement with the Plan. The Credentialing team cannot proces the application until all required materials are received. You will be notified by email if the application cannot be processed due to incomplete information.
  • Applicant requesting an initial affiliation with Point32Health will be credentialed through the HCAS process, utilizing CAQH’s ProView system, a central repository for credentialing information. Data from CAQH ProView will only be transmitted to plans with which clinicians are already contracted or are in the process of contracting. For more information about HCAS and its credentialing process, go to www.hcasma.org.
  • Get started by visiting CAQH ProView.

Federal regulations require that providers who render services to Medicaid members are screened by and enrolled with the appropriate state Medicaid agency. This requirement applies to providers who participate in Tufts Health RITogether or Tufts Health Together.

  • Once you are a participating provider, please review this flyer to guide you through getting started with us. It will get you started with registering for our secure portals, signing up for our monthly electronic newsletter, registering for electronic funds transfer and more.
  • We also encourage you to review our Tufts Health Plan Provider Manuals and our product page.