New Point32Health webpages to streamline your operations
We are announcing a few integrated webpages to streamline the provider experience, including our Prior Authorization, Forms, and Vendor Programs pages.
Insights and Updates for Providers
October 2024
Submitting behavioral health claims and appeals
Beginning Nov. 1, submit all BH claims and appeals directly to Harvard Pilgrim for Commercial members — even for dates of service prior to Nov. 1, 2023.
New 2025 CPT and HCPCS codes
Point32Health will update systems and policies to reflect new 2025 CPT and HCPCS codes beginning Jan. 1, 2025.
What’s ahead for our Medicare plans for 2025
We are highlighting some updates to our Medicare Advantage plans for 2025, in connection with industrywide changes stemming from the IRA.
Updated address for Harvard Pilgrim mail correspondence
We are updating the address for our Harvard Pilgrim Health Care line of business from Quincy to our corporate address in Canton.
New product offering for Jan. 1, 2025
Point32Health will offer a new Harvard Pilgrim Health Care Commercial product, PPO Access, beginning Jan. 1, 2025.
Important updates on reaching us by phone, email, and fax
We are providing a reminder on how to reach us for certain transactions, including a new fax number, along with resource guides for our secure portals.
2025 Part B Step Therapy program
Updates to the Part B Step Therapy program for Tufts Medicare Preferred, Tufts Health Plan Senior Care Options, and Tufts Health One Care take effect Jan. 1.
Claims editing platform updates
Updates to our claims editing platforms originally anticipated for Oct. 1, 2024 have been delayed and are now be expected to begin Jan. 1, 2025.
Rhode Island Medicaid rate updates
Point32Health is implementing reimbursement rate updates for Tufts Health RITogether providers, in accordance with recent direction from the Rhode Island EOHHS.
New community BH clinics program in RI
Rhode Island has recently designated several CCBHCs, which will be available to Tufts RITogether patients in need of specialized behavioral health care as of Oct. 1, 2024.
Point32Health Obstetrics and Gynecology Payment Policy
Our new integrated Point32Health Obstetrics and Gynecology Payment Policy will replace our previous Harvard Pilgrim and Tufts Health Plan policies.
Billing for NH community-based mental health organizations
Providers treating children with severe mental illness through one of New Hampshire’s 10 Community Mental Health Centers may be able to bill for certain services.
Enrollment/screening for RI Medicaid providers
Rhode Island Medicaid providers should complete screening and enrollment with the state Medicaid program to ensure continued participation in our Tufts Health RITogether network.
Electronic corrected claims reminder
As a reminder, corrected claims submissions should not include documentation of previous payment information, as this may delay processing.
Point32Health Medical Necessity Guideline updates
Providers and their office staff can refer to this chart to review changes and updates to the Point32Health Medical Necessity Guidelines.
Synagis coverage for the 2024-2025 RSV season
We would like to remind providers that Synagis requires prior authorization, and how to request authorization for the 2024-2025 season.
Point32Health medical drug program updates
Providers and their office staff can review the following chart for changes and updates to our coverage program for medical drugs.