Insights and Updates for Providers

March 2023

Tufts Health Together Accountable Care Organizations for 2023

Tufts Health Together—ACOs

We’re pleased to announce that two Tufts Health Together plans have been selected by MassHealth as part of their Accountable Care Organization (ACO) program: Tufts Health Together with UMass Memorial Health and Tufts Health Together with Cambridge Health Alliance.

Integration and Commercial migration: reminders and updates

All products

Please remember to visit our Integration FAQ for answers to common questions about the combination of Harvard Pilgrim Health Care and Tufts Health Plan under our parent organization, Point32Health, and read this article for recently added information and reminders.

Expanded access to CGP for advanced solid tumors

Tufts Health Direct  |  Tufts Health RITogether  |  Tufts Health Together

Point32Health and Foundation Medicine, Inc. previously expanded access to comprehensive genomic profiling (CGP) for Harvard Pilgrim Commercial members and Tufts Health Plan Commercial members, and that coverage now also applies to Tufts Health Together, Tufts Health RITogether, and Tufts Health Direct members.

Harvard Pilgrim Provider Portal required fields update

Harvard Pilgrim Health Care Commercial

Harvard Pilgrim is making an update to the electronic prior authorization request submission process in HPHConnect, effective May 4, 2023. As a result, Contact Name and Contact Info will become required fields when submitting an outpatient service transaction.

Inactive account management for secure portal

All Tufts Health Plan Products

Please regularly review your practice’s Tufts Health Plan secure portal account to ensure that the list of registered users is accurate. We will be removing inactive user accounts beginning March 31; any inactive users who still require access should log in before then.

Reminder: Telehealth Reimbursed at Pre-Pandemic Rate

Harvard Pilgrim and Tufts Commercial

As a reminder, Point32Health resumed our pre-pandemic telehealth reimbursement practices for Harvard Pilgrim Health Care and Tufts Health Plan providers, in keeping with guidance provided by the states we serve, for dates of service beginning March 1, 2023.

Billing for telehealth

Tufts Health Plan SCO  |  Tufts Health Together  |  Tufts Health Unify

Tufts Health Plan is making some updates to our payment policies related to the submission of professional claims for services provided via telehealth, and also reprocessing certain previously denied claims to be reimbursed, in accordance with MassHealth’s MCE Bulletin 95.

Reminder: MassHealth Unified Formulary

Tufts Health Together

Effective April 1, 2023, Tufts Health Together–MassHealth MCO Plan and ACPPs, in conjunction with the other Medicaid managed care organizations (MCOs) in the Commonwealth, will be utilizing MassHealth’s Unified Formulary for pharmacy medications and for select medical benefit drugs.

Requests for assisted reproductive technology services

Harvard Pilgrim Health Care Commercial  |  Tufts Health Direct  |  Tufts Health Plan Commercial

We would like to provide some clarity regarding the correct processes for initiating prior authorization requests for assisted reproductive technology services for members of Harvard Pilgrim Health Care Commercial products, Tufts Health Plan Commercial products, and Tufts Health Direct.

Point32Health Medical Necessity Guideline updates

Uncategorized

Providers and office staff can refer to the following chart to review changes and updates to Point32Health’s Medical Necessity Guidelines (MNGs), information about newly developed MNGs, and more.

Abortion and abortion-related care update

Massachusetts products

The Reproduction and Gender-Affirming Care Act expands legal protections for practitioners providing services related to pregnancy terminations and gender-affirming care within the state of Massachusetts, and requires coverage of abortion and related services without cost share.

Point32Health’s access to care standards

Uncategorized

Harvard Pilgrim Health Care and Tufts Health Plan, the brands under the Point32Health umbrella, maintain policies that outline network practitioner standards regarding clinician availability, timeliness of appointments, and telephone accessibility, among other things.

Members’ rights and responsibilities

Uncategorized

Please take a moment to review this information on Harvard Pilgrim and Tufts Health Plan’s members’ rights and responsibilities. And because this information may vary among states and product lines, please be sure to read the related pages in the respective provider manuals.

Hydration therapy reimbursement update

Harvard Pilgrim Health Care Commercial

Effective for dates of service beginning May 1, 2023, Harvard Pilgrim Health Care’s Commercial plans will no longer provide reimbursement for hydration therapy (CPT codes 96360, 96361, J7030, J7040, J7042, J7050, J7060, J7070, J7120, or J7121) when billed without a requisite diagnosis on the claim for members older than 18 years of age.

Join us for a provider training

All products

Point32Health will offer a number of trainings in March, some pertaining broadly to Point32Health, some specific to Harvard Pilgrim, and some specific to Tufts Health Plan. Click the links in this article to register!

Updates and reminders

Tufts Health Plan SCO  |  Tufts Health Public Plans  |  Tufts Medicare Preferred

Read more for helpful updates and reminders to keep in mind this month. Topics include required data elements for coordination of benefits claims, opioid treatment performance specifications, and reminders regarding stretchers and the standard form for chemotherapy prior authorization.