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
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.
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.
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.
Patient consent to share SUD medical records
We’re reminding providers who provide substance use disorder services to use a patient consent form for privacy requirements.
Get patients in for preventive services and screenings
We encourage providers to schedule patients for preventative service and screenings for overall patient well-being and to support successful HEDIS scores.
Coordination of benefits reminder
We encourage providers to review our Coordination of Benefits Quick Reference Guide to assist in navigating claims for patients with more than one source of health care coverage.
Reminder: member eligibility and non-covered services
It’s important to check members’ benefits and eligibility prior to initiating care or referring them for a service to ensure that the service is covered under their plan.
Authorization: reminders and tips
To ensure patients receive timely access to services and providers receive appropriate reimbursement, we recommend the following best practices around requesting authorization, determining eligibility, and more.
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.
Point32Health Allergy Testing and Treatment Payment Policy
We are introducing a new integrated Point32Health Allergy Testing and Treatment Payment policy, which will replace the previous legacy policies.
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.
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.