Behavioral Health: New webpage and insourcing occurs Nov. 1
We’ve insourced behavioral health and launched a new behavioral health webpage.
Insights and Updates for Providers
November 2023
You’re invited to a claims consultation in Connecticut!
Claims consultation event coming to Connecticut on Nov. 8.
Join a November training
Upcoming provider trainings: referral and authorization, behavioral health, and more!
Updates on Rhode Island for 2024
Read about our 2024 commercial migration, new product, and more!
SNF submission of SC-1 form for MassHealth members
SNFs must submit an SC-1 form timely to avoid claim denials.
New HEDIS® tip sheets for WCV and FUA measures
We’ve developed new HEDIS® tip sheets for your practice.
Reminder on COVID-19 coverage
Reminders for providers regarding our COVID-19 coverage.
Expanding our kidney health management program
Expanding Monogram Health kidney disease program to Tufts Health Direct.
Tufts Health Direct outpatient cost sharing updates
Effective Jan. 1, 2024, the following outpatient cost share updates will apply to Tufts Health Direct members:
Point32Health Medicare products: 2024 benefit changes
2024 benefit changes for Point32Health Medicare Advantage/Senior Products plans.
MassHealth nursing facility rate add-on codes
New reimbursement for nursing facility rate add-on codes.
New ICD-10 code for HIV PrEP
HIV PrEP billing requirements and new ICD-10 code.
New 2024 CPT and HCPCS codes
2024 CPT and HCPCS codes accepted for Jan. 1, 2024.
Point32Health 2024 fee schedule updates
Point32Health’s fee schedules will be updated in 2024.
Integrated payment policies and POS code update
Introducing new integrated Point32Health payment policies.
Model of Care Training
Tufts Health Plan Senior Care Options (SCO) PCPs and high-volume specialists are required by the Commonwealth of Massachusetts and CMS to complete the Annual SCO Model of Care Training by Jan. 30, 2024.
Senior Products: 2024 formulary coverage changes
Point32Health Medicare Advantage/Senior Products drug formularies: 2024 updates.
New and updated Medical Necessity Guidelines
New and updated Medical Necessity Guidelines for Jan. 1, 2024.
Point32Health medical drug program updates
Updates to medical drug prior authorization programs for Jan. 1, 2024.
Pharmacy coverage changes
Jan. 1, 2024 Pharmacy coverage changes for various Point32Health products.
Preferred oncology biosimilars for 2024
Preferred products for the bevacizumab, rituximab, and trastuzumab drug classes.
MassHealth updates to Unified Formulary
MassHealth recently announced the following updates to their Unified Formulary.
Coverage updates – inhaled corticosteroids
Flovent HFA and Flovent Diskus discontinuing and other coverage updates.
Other 2024 Pharmacy program updates
2024 Pharmacy updates: Harvard Pilgrim commercial, Tufts commercial, Tufts Health Direct.
Provider directory attestation for facilities
New attestation form available on HPHConnect to confirm directory information.
Point32Health’s access to care standards
Access to care policies for Tufts Health Plan and Harvard Pilgrim.
Identifying alternate providers when terminating from the network
When terminating from network, please identify two alternate available providers.
Point32Health PPACA coverage alignment
Jan. 1 coding/coverage updates to Harvard Pilgrim PPACA policy.
Complex Care Management services
Point32Health provides care management services for adult and pediatric members.
About Our Chronic Condition Management Programs
Point32Health’s approach to chronic condition management through patient-centered care.