In the wake of the cybersecurity incident we identified on April 17, we have returned our core Harvard Pilgrim Health Care systems, business functions, and tools online and wanted to share an overview of recent announcements.
Insights and Updates for Providers
AbleTo’s personalized therapy program is now available to Tufts Health Direct, Tufts Health Together-MCO, and Tufts Medicare Preferred members, and will continue to be offered to Harvard Pilgrim Health Care commercial and Stride (HMO/HMO-POS) Medicare Advantage members.
Integra will soon begin to assume management of the DMEPOS provider network for Point32Health’s Senior Products, starting on July 1, 2023 for Tufts Medicare Preferred and Tufts Health Plan Senior Care Options, and on Sept. 1, 2023 for Harvard Pilgrim Stride (HMO)(HMO-POS) Medicare Advantage.
Point32Health is pleased to announce that we will be opening the doors to our Canton office this summer to host providers for claims consultations. The event will be an opportunity for providers to meet with our Provider Relations team, who will be available as a resource to support you by answering questions you may have about claims.
Effective immediately, any products listed on the Harvard Pilgrim Health Care commercial, Tufts Health Plan commercial, and Tufts Health Direct formularies that have not been approved by the FDA will be excluded from coverage, in alignment with the information listed on our Evidence of Coverage documents and Member Handbooks.
Point32Health’s July webinars offer providers the opportunity to ask questions and share feedback while gaining the latest information on products, processes, systems and more — and registering is easy!
We’re sharing some updates regarding medical benefit drug coverage and the MassHealth Unified Formulary, which will apply for Tufts Health Together beginning July 31, 2023.
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.
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
At Point32Health, we believe collaboration and communication between primary care physicians and behavioral health care providers are pivotal to quality patient care, helping to minimize adverse medication interactions, allowing for better management of treatment, and improving follow‐up for patients with behavioral health and other medical conditions.
Point32Health would like to highlight some information and reminders that may help support you in your efforts to adhere to the guidelines and standards of care set forth by the Follow-Up After Hospitalization for Mental Illness (FUH) and Initiation and Engagement of Substance Use Disorder Treatment (IET) HEDIS measures.
As a reminder, psychiatric and substance use disorder treatment facilities are required to submit discharge summaries within 24 hours of member discharge from an inpatient, residential treatment, or partial hospitalization program. This article outlines requirements for Point32Health members.
There are several depression screening tools available for use in the primary care setting, which Point32Health recommends as a starting point for diagnosis and coordination of follow-up care, and we also offer helpful resources and information.
Point32Health has updated our applicable Tufts Health Plan systems, as well as the Tufts Health Plan Evaluation and Management Professional Payment Policy, to reflect MassHealth guidance on coverage of provider-to-provider e-consults.
Please be aware that for dates of service beginning Sept. 1, 2023, the readmission policies for DRG facilities for Tufts Health Direct, Tufts Health Together, and Tufts Health RITogether will be expanded to apply to providers reimbursed at a case rate.
We’re offering some reminders and clarifying information on billing for telehealth services for Tufts Health Plan Senior Care Options, Tufts Health Together, and Tufts Health Unify members.