Point32Health Site of Service Payment Policy
We are introducing a new integrated Point32Health Site of Service Payment Policy as part of our work of streamlining policies and processes.
Insights and Updates for Providers
July 2025
Coverage changes for Stelara and biosimilars
There will be upcoming coverage changes related to Stelara and biosimilars, and we recommend prescribers write a new prescription to aid the transition.
OneTouch test strips moving to non-formulary
There will be changes to coverage for One Touch Test Strips and One Touch blood glucose monitors for Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, and Tufts Health Direct members.
Prior authorization and claims denials for Maine
Claims that do not have the required prior authorization could receive a penalty fee for Maine members of Harvard Pilgrim Health Care fully insured Commercial plans.
Advance notice for TIN change or addition
Practices updating their practice information with new or additional Tax Identification Numbers will be required to provide 60 days advance written notice to Harvard Pilgrim.
Update on Tufts Health Together MCO for 2026
We are offering additional information and answers to questions for providers regarding the transition away from Tufts Health Together MassHealth MCO.
Painter’s union administration updates
Coverage for the Painters & Allied Trades District Council No. 35 union is changing from a shared administrative account to a standard self-funded account.
Registration reminder for Electronic Visit Verification
Providers who haven’t completed their Electronic Visit Verification are encouraged to complete the process as soon as possible per the Massachusetts Executive Office of Health and Human Services.
New HEDIS tip sheet for PPC
Our Prenatal and Postpartum Care HEDIS Tip sheet offers insights and best practices for providers and can be referred to on our HEDIS tip sheet page.
Enrollment/screening for RI Medicaid providers
Rhode Island providers who have not yet completed screening and enrollment with the state Medicaid program should do so to continue participating in our Tufts Health RITogether network.
Reminders on pain management and opioid antagonists
We would like to offer some reminders for providers regarding pain management, including plans, alternative therapies, and coverage for opioid antagonists.
MassHealth to introduce CBHI-FIT program
MassHealth’s Children’s Behavioral Health Initiative is introducing its new Family-based Intensive Treatment program in September.
Reminder: Annual wellness visit covered by calendar year
Tufts Health Plan uses a calendar year for coverage of annual wellness visits for members of our senior products.
Help us keep directory information up to date
Providers must review and revalidate their information every 90 days to ensure accuracy of our Provider Directory, and notify Point32Health in advance of any changes.
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
Refer to the following chart for information regarding upcoming pharmacy coverage changes.