Tufts Health Together Accountable Care Organizations for 2023
Learn about Tufts Health Together ACO plans
Insights and Updates for Providers
March 2023
Integration and Commercial migration: reminders and updates
Visit our Integration FAQ for answers to common questions
Expanded access to CGP for advanced solid tumors
Our comprehensive genomic profiling coverage, offered through FMI, has expanded.
Harvard Pilgrim Provider Portal required fields update
Harvard Pilgrim is making updates in HPHConnect, our provider portal.
Inactive account management for secure portal
We will be removing inactive user accounts from the Tufts Health Plan secure portal
Reminder: Telehealth Reimbursed at Pre-Pandemic Rate
Telehealth reimbursement update for commercial Massachusetts, Rhode Island, and Maine.
Billing for telehealth
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
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
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
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
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
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
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
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
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
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.