Facility attestation functionality in Tufts Health Plan Provider Portal
We’ve implemented new functionality in the Tufts Health Plan secure Provider Portal, which allows facilities to review their provider data and report necessary changes.
Insights and Updates for Providers
June 2025
Update on referral requirement for home health agency care
Effective June 15, 2025 a provider/discharging facility order will satisfy the referral requirement for home health agency care for Tufts Medicare Preferred and Tufts Health Plan Senior Care Options.
Patient consent to share SUD medical records
We’re reminding providers who provide substance use disorder services to use a patient consent form for privacy requirements.
Updates to observation stay authorizations
Effective Aug. 1, 2025, we will no longer authorize observation stays longer than 48 hours for Tufts Health Together, Tufts Health RITogether, and Tufts Health One Care.
Prior authorization for certain Part B drugs
A recent temporary system error impacted the required authorization for a number of Medicare Part B drugs, and prior authorization should be submitted if not previously obtained.
Get patients in for preventive services and screenings
We encourage providers to schedule patients for preventative service and screenings for overall patient well-being and to support successful HEDIS scores.
Coordination of benefits reminder
We encourage providers to review our Coordination of Benefits Quick Reference Guide to assist in navigating claims for patients with more than one source of health care coverage.
Reminder: member eligibility and non-covered services
It’s important to check members’ benefits and eligibility prior to initiating care or referring them for a service to ensure that the service is covered under their plan.
Authorization: reminders and tips
To ensure patients receive timely access to services and providers receive appropriate reimbursement, we recommend the following best practices around requesting authorization, determining eligibility, and more.
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.
MassHealth updates to Unified Formulary
MassHealth recently announced updates to the MassHealth Unified Formulary, which will take effect on May 12, 2025.
Point32Health Allergy Testing and Treatment Payment Policy
We are introducing a new integrated Point32Health Allergy Testing and Treatment Payment policy, which will replace the previous legacy policies.