Point32Health has developed policies regarding the administrative termination of providers in our network who have not provided services to our members for two years or longer, which you can find in our respective Harvard Pilgrim Health Care and Tufts Health Plan Provider Manuals.
Up-to-date provider data, including but not limited to the information displayed in directories, is of vital importance for health care consumers, health plans, and other providers — and we rely on providers to support maintaining information that accurately reflects network availability. We view lack of services rendered to our members by participating providers as an indicator of a potential data inaccuracy. As a result, we systematically review our Harvard Pilgrim and Tufts Health Plan provider network information on an annual basis, and may administratively terminate providers who have not provided services to our members for the immediate prior two years.
Prior to termination, Point32Health will use our best efforts to contact the provider and/or the provider organization the provider is affiliated with, to request confirmation of whether the provider would like to remain a participating provider despite their inactivity. If we’re unable to verify the provider’s network information, we may proceed with termination.
Please contact [email protected] if you receive a termination notice for inactivity but wish to remain a participating provider. A provider that is terminated through this process, but later would like to participate in the Harvard Pilgrim Health Care and/or Tufts Health Plan network may reapply to become a participating provider through our standard credentialing and enrollment process.
Please refer to the “Provider inactivity and administrative termination of network providers” sections of the following Provider Manuals for complete information:
- Harvard Pilgrim Commercial
- Harvard Pilgrim StrideSM (HMO)/(HMO-POS) Medicare Advantage
- Tufts Health Plan Commercial (Providers chapter)
- Tufts Health Public Plans (Providers chapter)
- Tufts Health Plan Senior Products (Providers chapter)