We’re pleased to announce that two Tufts Health Together plans have been selected by MassHealth as part of their Accountable Care Organization (ACO) program: Tufts Health Together with UMass Memorial Health and Tufts Health Together with Cambridge Health Alliance.
Please remember to visit our Integration FAQ for answers to common questions about the combination of Harvard Pilgrim Health Care and Tufts Health Plan under our parent organization, Point32Health, and read this article for recently added information and reminders.
Point32Health and Foundation Medicine, Inc. previously expanded access to comprehensive genomic profiling (CGP) for Harvard Pilgrim Commercial members and Tufts Health Plan Commercial members, and that coverage now also applies to Tufts Health Together, Tufts Health RITogether, and Tufts Health Direct members.
Harvard Pilgrim is making an update to the electronic prior authorization request submission process in HPHConnect, effective May 4, 2023. As a result, Contact Name and Contact Info will become required fields when submitting an outpatient service transaction.
Please regularly review your practice’s Tufts Health Plan secure portal account to ensure that the list of registered users is accurate. We will be removing inactive user accounts beginning March 31; any inactive users who still require access should log in before then.
As a reminder, Point32Health resumed our pre-pandemic telehealth reimbursement practices for Harvard Pilgrim Health Care and Tufts Health Plan providers, in keeping with guidance provided by the states we serve, for dates of service beginning March 1, 2023.
Tufts Health Plan is making some updates to our payment policies related to the submission of professional claims for services provided via telehealth, and also reprocessing certain previously denied claims to be reimbursed, in accordance with MassHealth’s MCE Bulletin 95.
Effective April 1, 2023, Tufts Health Together–MassHealth MCO Plan and ACPPs, in conjunction with the other Medicaid managed care organizations (MCOs) in the Commonwealth, will be utilizing MassHealth’s Unified Formulary for pharmacy medications and for select medical benefit drugs.
We would like to provide some clarity regarding the correct processes for initiating prior authorization requests for assisted reproductive technology services for members of Harvard Pilgrim Health Care Commercial products, Tufts Health Plan Commercial products, and Tufts Health Direct.
Providers and office staff can refer to the following chart to review changes and updates to Point32Health’s Medical Necessity Guidelines (MNGs), information about newly developed MNGs, and more.
The Reproduction and Gender-Affirming Care Act expands legal protections for practitioners providing services related to pregnancy terminations and gender-affirming care within the state of Massachusetts, and requires coverage of abortion and related services without cost share.
Harvard Pilgrim Health Care and Tufts Health Plan, the brands under the Point32Health umbrella, maintain policies that outline network practitioner standards regarding clinician availability, timeliness of appointments, and telephone accessibility, among other things.
Please take a moment to review this information on Harvard Pilgrim and Tufts Health Plan’s members’ rights and responsibilities. And because this information may vary among states and product lines, please be sure to read the related pages in the respective provider manuals.
Effective for dates of service beginning May 1, 2023, Harvard Pilgrim Health Care’s Commercial plans will no longer provide reimbursement for hydration therapy (CPT codes 96360, 96361, J7030, J7040, J7042, J7050, J7060, J7070, J7120, or J7121) when billed without a requisite diagnosis on the claim for members older than 18 years of age.
Point32Health will offer a number of trainings in March, some pertaining broadly to Point32Health, some specific to Harvard Pilgrim, and some specific to Tufts Health Plan. Click the links in this article to register!
Read more for helpful updates and reminders to keep in mind this month. Topics include required data elements for coordination of benefits claims, opioid treatment performance specifications, and reminders regarding stretchers and the standard form for chemotherapy prior authorization.
We’re pleased to announce that this month marks the launch of a combined Point32Health provider newsletter, Insights and Updates for Providers, which will deliver news and information for the legacy plans Harvard Pilgrim Health Care and Tufts Health Plan in one handy place.
Point32Health began utilizing Optum RX as the pharmacy benefit manager for all lines of business as of Jan. 1, 2023 and streamlined utilization management for pharmacy and medical drugs. Keep the following in mind when requesting authorization for Harvard Pilgrim and Tufts Health Plan members.
Harvard Pilgrim Health Care and OncoHealth are implementing a step therapy/preferred product strategy for a number of drug classes, effective for dates of service beginning April 1, 2023 for Harvard Pilgrim Commercial members.
As of April 1, 2023, Harvard Pilgrim’s Commercial and Stride (HMO)/(HMO-POS) Medicare Advantage plans will no longer use OncoHealth for radiation oncology medical management.