Extension of authorization waiver for admission to MA sub-acute and rehab facilities
We’re extending the authorization waiver for admissions to sub-acute and rehab facilities.
Insights and Updates for Providers
April 2024
Claims system upgrade for select Medicare products
We’re updating some Medicare claims systems — no provider action required.
Pilot program offers in-home urgent care
Select Senior Products members can opt into our in-home urgent care program, instED.
Jimmo Settlement: reminders and provider resources
A recent CMS memo clarifies coverage associated with the Jimmo Settlement.
Reminder: balance billing prohibited by Point32Health
As a reminder, Point32Health does not allow balance billing of our members.
Enrollment/screening for RI Medicaid providers
Rhode Island Medicaid providers must complete Medicaid screening and enrollment.
Updates to medical drug claims editing logic
We’re updating medical drug claims editing logic to remove certain edits.
Utilization management update for home health care services
We’re updating home health care UM requirements for quality and efficiency.
MNG update: Non-Emergency Medical Transportation
Integrated Point32Health Medical Necessity Guidelines for Non-Emergency Medical Transportation.
Billing update for mental health center services
MassHealth updated minimum rates for certain services provided by mental health centers.
Standard form for Applied Behavior Analysis prior authorization requests
A standard authorization form for ABA services has been adopted.
Medication for Opioid Use Disorder: buprenorphine resources and training
We offer resources and guidelines for prescribing buprenorphine for opioid use disorder.
Complex Care Management services
Point32Health provides complex care management services individually tailored to patients.
About Our Chronic Condition Management programs
Point32Health’s chronic condition management programs reinforce clinician treatment plans.
Importance of screening for unhealthy alcohol use
Screen for unhealthy alcohol/substance use in the primary care setting.
Point32Health Medical Necessity Guideline updates
Read more to review updates to Point32Health Medical Necessity Guidelines.
Point32Health medical drug program updates
New and updated Point32Health medical drug prior authorization programs.
Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
Adalimumab biosimilar strategy for RITogether
Adalimumab biosimilars have been added at preferred status to the formulary.
Reminder: trastuzumab biosimilar strategy
Reminder of our biosimilar strategy for trastuzumab oncology drugs.
Individual Consideration Services Payment Policy
The Individual Consideration Services Payment Policy is being updated effective June 1.
Point32Health integrates Acupuncture Payment Policy
We have created an integrated Point32Health Payment Policy for Acupuncture.
Upcoming training opportunities
We invite you to join one of our many training sessions for you and your office staff.