Back to Insights and Updates for ProvidersJune 2023

Billing updates for Tufts Health Plan providers

All Tufts Health Plan Products

Point32Health would like to keep our providers apprised of a number of updates and reminders related to billing practices for various services and Tufts Health Plan products:

Billing for behavioral health crisis evaluation: Tufts Health Together

As we communicated previously, MassHealth now requires acute hospitals to bill directly for behavioral health crisis evaluation for Tufts Health Together members who present in the ED. Hospitals may choose to subcontract out for these services; however, they must submit the claims using per diem code S9485.

In addition, we would like to remind providers that neglecting to include the admission type on these claims will cause the claim to deny. To ensure claims are paid properly, please be sure to include one of the following admission types:

  • Urgent
  • Emergent
  • Trauma Center

For more information, please refer to the Outpatient Behavioral Health (Mental Health & Substance Use Disorder) Professional Payment Policy.

Billing for inpatient hospital stays: all Tufts Health Plan products

As a reminder, when billing for inpatient hospital stays, providers should make sure the number of units and dates are the same on the claim. If they do not match, the claim will be denied and providers will need to submit a corrected claim. Please note that, in alignment with guidance from the Centers for Medicare and Medicaid Services (CMS), providers should not be billing room and board for the discharge date.

Use the most up-to-date CMS-1500 claims form: all Tufts Health Plan products

Please use the most updated CMS-1500 form when submitting claims for members of any of our Tufts Health Plan products. Previous versions of the form will no longer be accepted, and claims will be denied. If you still have stock of the old forms, please discard them and order the current form via WB Mason.

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Senior Manager, Provider Communications

Joseph O’Riordan, Jesse Salvato, Stephen Wong,

Kristin Edmonston,
Production Coordinator

Kristina Cicelova,
Graphic Designer