Register for a claims consultation event near you!
Claims consultation events coming in RI, MA, NH, CT, and ME.
Insights and Updates for Providers
October 2023
Address change for Harvard Pilgrim Stride
The mailing address for all Harvard Pilgrim Stride claims submissions has changed.
Tufts Health Unify becomes Tufts Health One Care
Effective Jan. 1, 2024, Tufts Health Unify is changing its name to Tufts Health One Care.
Telehealth billing reminders and MassHealth guidance
Reminders on adhering to billing requirements identified in MassHealth bulletins 355, 364, and 95.
Enrollment/screening process for Medicaid providers
Providers who render services for Medicaid members must be screened by and enrolled with the appropriate state Medicaid agency.
Introducing Our Chief Medical Officer Glenn Pomerantz, MD, JD
Point32Health has appointed Glenn Pomerantz, MD, JD as our new Chief Medical Officer.
Update on commercial migration: MA and RI markets
Updates on migration for Point32Health commercial products in Massachusetts and Rhode Island.
Preparing for Behavioral Health Insourcing
Please refer to these tools and resources related to our behavioral health program, which insources on Nov. 1, 2023.
New portal functionality for Tufts Health RITogether
For Tufts Health RITogether members, providers will soon have more electronic portal functionality than ever before.
New HEDIS® tip sheets now available
Point32Health has developed new tip sheets for three HEDIS measures.
BH screening for children and adolescents in the primary care setting
Reminder: it’s important to offer children routine behavioral health screening.
Help us keep directory information up to date
Review and verify the accuracy of demographic data at least quarterly.
Inform Point32Health if you offer concierge medicine services
Providers who are planning to offer concierge medicine services to eligible members are required to provide advance notice.
Well-child visits and vaccines for adolescents
Learn more about vaccines and screenings recommended annually for patients between ages 12-21.
Tips for avoiding unnecessary denials
Reminders to help avoid unnecessary claim denials and rejections for CareLink members.
Step Therapy Protocols and Exceptions
Learn more about mandatory exceptions in step therapy protocols.
2024 Part B Step Therapy program
New requirements will apply to the 2024 Part B Step Therapy program.
Synagis coverage for the 2023-2024 RSV season
Point32Health would like to remind providers of our Synagis (palivizumab) policy for the 2023-2024 season.
Coverage updates – inhaled corticosteroids
Brand name Flovent HFA and Flovent Diskus will be discontinued at the end of 2023.
MassHealth updates to Unified Formulary
MassHealth recently announced the following updates to the MassHealth Unified Formulary, effective Dec. 4, 2023.
Pharmacy Coverage Changes
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
Point32Health Medical Necessity Guideline updates
Review changes and updates to Point32Health’s Medical Necessity Guidelines (MNGs), information about newly developed MNGs, and more.
Point32Health medical drug program updates
Review changes and updates to Point32Health’s medical drug program.
Integrated Point32Health payment policies
Point32Health has developed some integrated Point32Health Payment Policies.
Point32Health billing updates
Point32Health is making updates to our billing requirements for certain products.
Federal waiver requirement to prescribe buprenorphine eliminated
Read about federal changes regarding prescribing buprenorphine and training requirements.