Payment update: pre-admission testing for inpatient admissions
Point32Health is updating our policy related to the reimbursement of pre-admission testing for inpatient admissions, effective for dates of service beginning July 1, 2025.
Insights and Updates for Providers
May 2025
Sign up for Electronic Funds Transfer
If you’re currently receiving paper checks, switch to electronic funds transfer through Payspan for quicker access to funds, greater convenience and efficiency, and more!
Reminder: updates to Inpatient Hospital Admissions Payment Policy
As we announced in last month’s issue of Insights and Updates to Providers, Point32Health wants to remind our provider partners that we are making updates to our Inpatient Hospital Admissions Payment Policy, effective for dates of service beginning June 1, 2025.
Patient navigation services for breast and cervical cancer screening
We encourage providers to offer patient navigation services to better personalize their approach to care for patients receiving breast and cervical cancer screenings.
HEDIS tip sheets for measures related to patients with diabetes
Point32Health has a number of HEDIS tip sheets that highlight best practices specific to measures related to patients with diabetes.
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.
Concurrent Use of Opioids and Benzodiazepines tip sheet
CMS has a Star Measure aimed at assessing and discouraging the use of opioids and benzodiazepines together due to risk of overdose, and our new tip sheet offers additional guidance.
Point32Health’s access to care standards
Our access to care/practice site standards policies outline network practitioner standards regarding clinician availability, timeliness of appointments, and telephone accessibility, among other things.
Clarified billing reminder: ambulatory surgical center services
We’re offering a reminder and some additional clarification concerning correct coding practices to keep in mind when billing for ambulatory surgical center services.
Updates to Inpatient Hospital Admissions Payment Policy
Point32Health is making updates to our Inpatient Hospital Admissions Payment Policy, effective for dates of service beginning June 1, 2025.
Help us keep directory information up to date
Please review and revalidate your practice information every 90 days to ensure accuracy of our Provider Directory, and notify Point32Health in advance of any changes.
Announcing new integrated Point32Health payment policies
We have developed new integrated Point32Health Payment Policies pertaining to advanced practice providers, newborn care, and audiology, and will be archiving their respective legacy equivalents.
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.
Language interpretation services reminder
We’d like to remind our provider partners that Point32Health offers access to free language interpretation services to facilitate the care and treatment of your non-English-speaking patients.
Living Well Community – upcoming programs for providers and members
Our 2025 Living Well Community offers free wellness-related webinars and classes, and is continuing to expand its sessions to include webinars on nutrition, food choices, and more.
Content centralized to Point32Health provider website
We have finished consolidating content from our legacy websites onto the centralized Point32Health provider website for a more streamlined provider experience!
Members’ rights and responsibilities
Point32Health’s information on members’ rights and responsibilities is provided to clinicians at the time of member enrollment, and can be found in the Provider Manuals.
Coordinating care for medical and behavioral health
Point32Health encourages, and has resources to support, communication among medical and behavioral health care providers working with a shared patient to support whole-person care.
Correct coding reminders
We’re offering reminders of correct coding practices when completing a UB-04 claim, and when billing for services ambulatory surgical center services.
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.
New substance use disorder treatment HEDIS tip sheet
Our new HEDIS® tip sheet offers insights and best practices related to the Initiation and Engagement of Substance Use Disorder Treatment (IET) measure.
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.
Our contact information
We want to highlight some key contact information and resources for providers contacting us for support, such as our online provider portals and Provider Services team.
New Payment Policy and billing for hospital at home
Point32Health has developed a Payment Policy for Inpatient Hospital Admissions, which includes billing instructions for hospital at home care, which Point32Health reimburses for contracted providers when medically necessary.
HEDIS MY2024 medical record requests
As required by NCQA and CMS, Point32Health will send HEDIS MY2024 medical record requests via mail to providers for all Point32Health products beginning in February 2025.
Living Well – 2025 program offerings for providers and members
We’re pleased to announce enhancements to our virtual Living Well program for the year ahead, including webinar series on a number of fascinating topics.
CAQH Provider Data Portal updates and upcoming training
If you utilize the CAQH Provider Data Portal to review and update your provider directory information, you’ll soon see some additional required fields.
Help us keep directory information up to date
Please review and revalidate your practice 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.
Prior authorization update for administration of CAR T-cell drugs
In response to provider feedback, we will no longer require prior authorization for the preparation and administration of the following CAR T-cell therapy medications.
New content on Point32Health provider website
In support of our ongoing efforts to continually improve and simplify your engagement with us, we’re thrilled to announce that we’ve developed four additional Point32Health provider pages.
New HEDIS tip sheets for SPC and FMC measures
We’re pleased to introduce HEDIS® tip sheets for Statin Therapy for Patients with Cardiovascular Disease and Follow Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions.
Clinical practice guidelines updates
Point32Health maintains a number of clinical practice guidelines, which you can find on the Clinical Practice Guidelines section of our provider website, and we have recently updated some.
Point32Health’s access to care standards
Our applicable access to care/practice site standards policies outline network practitioner standards regarding clinician availability, timeliness of appointments, and telephone accessibility, among other things.
Point32Health Medical Necessity Guideline updates
Providers can refer to the following chart to review updates and changes to our Medical Necessity Guidelines.
Point32Health medical drug program updates
Providers can refer to the following chart to review updates and changes to our medical benefit drug program.
Modifiers and reminders for home infusion therapy
We’re offering some reminders regarding the reporting of home infusion therapy services. Additionally, as of Feb. 1, 2025, please include modifier SH or SJ as appropriate.
Point32Health Medical Necessity Guideline updates
Providers and office staff can refer to the following chart to review changes and updates to Point32Health’s Medical Necessity Guidelines.
Point32Health medical drug program updates
Providers and office staff can refer to the following chart to review updates to our medical benefit drug program.
Point32Health Vaccines and Immunizations Payment Policy
We have developed an integrated Point32Health Vaccines and Immunizations Payment Policy and archived the previous legacy Harvard Pilgrim Health Care and Tufts Health Plan policies.
New 2025 CPT and HCPCS codes
Point32Health will update systems and policies to reflect new 2025 CPT and HCPCS codes beginning Jan. 1, 2025.
Important updates on reaching us by phone, email, and fax
We are providing a reminder on how to reach us for certain transactions, including a new fax number, along with resource guides for our secure portals.
Point32Health Obstetrics and Gynecology Payment Policy
Our new integrated Point32Health Obstetrics and Gynecology Payment Policy will replace our previous Harvard Pilgrim and Tufts Health Plan policies.
Point32Health Medical Necessity Guideline updates
Providers and their office staff can refer to this chart to review changes and updates to the Point32Health Medical Necessity Guidelines.
Point32Health medical drug program updates
Providers and their office staff can review the following chart for changes and updates to our coverage program for medical drugs.