Insights and Updates for Providers

March 2023

Integration and Commercial migration: reminders and updates

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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.

Join us for a provider training

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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!

Introducing new newsletter and website

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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.

Pharmacy and medical drug authorization reminders

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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.

Register for upcoming provider trainings

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We’re pleased to launch our new integrated Provider Training and Events webpage, a one-stop-shop replacing the training pages on our legacy provider websites. You’ll find it easier than ever to view our training offerings and sign up for a session.

Billing reminders for vision services

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Point32Health would like to offer some reminders to provide clarity around the correct billing practices for vision claims for Harvard Pilgrim Health Care and Tufts Health Plan members, to help ensure that these claims are reimbursed appropriately.

Psychiatric Collaborative Model of Care billing reminder

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As a reminder, when billing Harvard Pilgrim and Tufts Health Plan members for services that are delivered through the Psychiatric Collaborative Model of Care, also referred to as Collaborative Care Model (CoCM), it’s important to use the correct procedure codes.

Point32Health Medical Necessity Guideline updates

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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.

Learn more about our integration

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Stay updated on the progress we have made since bringing Harvard Pilgrim Health Care and Tufts Health Plan together under the parent organization, Point32Health — and on what’s ahead in 2023.

Coming soon: New provider newsletter on Feb. 1

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Our new provider newsletter, Insights and Updates for Providers, which will feature news and information on Harvard Pilgrim Health Care and Tufts Health Plan, is available on Feb. 1, 2023!