Update on Tufts Health Together MCO for 2026
After careful consideration, together with MassHealth, Point32Health has decided to no longer offer Tufts Health Together MassHealth MCO, effective Jan 1, 2026.
Insights and Updates for Providers
May 2025
Payment update: pre-admission testing for inpatient admissions
Point32Health is updating our policy related to the reimbursement of pre-admission testing for inpatient admissions, effective for dates of service beginning July 1, 2025.
Sign up for Electronic Funds Transfer
If you’re currently receiving paper checks, switch to electronic funds transfer through Payspan for quicker access to funds, greater convenience and efficiency, and more!
HPHConnect Provider portal updates
We’re launching two updates to the HPHConnect provider portal as of May 12, 2025 to support greater security and improved search results.
GLP-1 weight management medication coverage changes
Point32Health is making changes related to coverage of GLP-1 weight management medications, and will be designating Zepbound as the preferred product as of July 1, 2025.
Reminder: updates to Inpatient Hospital Admissions Payment Policy
As we announced in last month’s issue of Insights and Updates to Providers, Point32Health wants to remind our provider partners that we are making updates to our Inpatient Hospital Admissions Payment Policy, effective for dates of service beginning June 1, 2025.
GIC product updates effective July 1
The 2025-2026 plan year for our Harvard Pilgrim/Group Insurance Commission products — Harvard Pilgrim Quality HMO and Harvard Pilgrim Explorer POS — begins on July 1, 2025.
Notice requirement for terminating practitioners
Please notify Tufts Health Plan with at least 90 calendar days’ written notice prior to the effective date of a primary care provider or specialist terminating from our network.
Patient navigation services for breast and cervical cancer screening
We encourage providers to offer patient navigation services to better personalize their approach to care for patients receiving breast and cervical cancer screenings.
Carelon molecular diagnostic testing program update
Our vendor partner for molecular diagnostic testing, Carelon, is implementing an update effective Aug. 1, 2025 regarding defining its service dates.
HEDIS tip sheets for measures related to patients with diabetes
Point32Health has a number of HEDIS tip sheets that highlight best practices specific to measures related to patients with diabetes.
Point32Health Medical Necessity Guideline updates
Refer to this chart to review changes and updates to Point32Health’s Medical Necessity Guidelines, information about newly developed MNGs, and more.
Point32Health medical drug program updates
Refer to this chart to review changes and updates to Point32Health’s medical drug program, including information about prior authorization, coverage updates, and more.
Pharmacy coverage changes
Please refer to this chart for information on updates to our Pharmacy coverage and Medical Necessity Guidelines.
Concurrent Use of Opioids and Benzodiazepines tip sheet
CMS has a Star Measure aimed at assessing and discouraging the use of opioids and benzodiazepines together due to risk of overdose, and our new tip sheet offers additional guidance.
Point32Health’s access to care standards
Our access to care/practice site standards policies outline network practitioner standards regarding clinician availability, timeliness of appointments, and telephone accessibility, among other things.