Important updates on reaching us by phone, email, and fax
We’re modifying the way we accept requests for authorizations, notifications, and referrals across Point32Health, and recommend electronic and fax options for greater efficiency.
Insights and Updates for Providers
May 2025
Learn how to get the most out of every moment!
Join us on Wednesdays in September for our upcoming Living Well webinar series: Healthy Habits to Get the Most Out of Every Moment.
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.
Metabolic Monitoring for patients on antipsychotic medications
Help ensure patients taking antipsychotic medications receive annual screenings by ordering in-office point of care HbA1c or fasting glucose tests for diabetes and monitoring cholesterol.
The importance of culturally appropriate health care
Point32Health provides interpretation services for hundreds of languages, along with cultural competency training opportunities, to ensure providers are mindful of patients’ cultural and linguistic needs.
Coordinating care for medical and behavioral health
Point32Health offers many resources, including our Coordination of Care Check List, for providers with patients living with chronic physical and/or mental illness.
Promoting the flu vaccine
September and October are good times to vaccinate against the flu, and providers play a vital role in keeping patients informed to make healthy decisions.
Reducing 30-day readmissions
Timely follow-up and patient education are key to ensuring effective transition of care interventions and preventing hospital readmissions within 30 days.
Billing charges on claims for same date of service
When billing for an office visit with more than one service, providers should report all service codes related to the visit on one claim.
HEDIS strategies: behavioral health and substance use
We are providing reminders and strategies for improvement on the FUH and IET HEDIS measures to maximize the opportunity for success.
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.
Provider Service Center email update
We encourage providers to use electronic options for a variety of transactions, as the Provider Service Center will be discontinuing its email account.
Administrative termination of inactive providers
We annually review our provider network and may terminate providers who have not provided services to our members in the past two years.
Reminder: Correct coding and claims edits
To ensure accurate claims processing, claims submitted to Point32Health are subject to regular edits based on regulatory guidelines, medical society recommendations, and more.
Psychiatric Collaborative Model of Care billing reminder
When billing our members for services delivered through the Psychiatric Collaborative Model of Care, it’s important to use the procedure codes identified here.
Correct coding edits effective Oct. 1, 2024
To align with industry standard coding practices, Point32Health is making updates to our General Coding and Claims Editing Payment Policy.
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 maternity and family planning webpages launch
We’ve launched maternity sections of our Point32Health and Harvard Pilgrim member websites for those in all stages of family planning and care.
New HEDIS tip sheet for GSD
We’ve developed a new HEDIS tip sheet related to the Glycemic Status Assessment for Patients with Diabetes measure, highlighting best practices to support your practice.
Contracting, Enrollment, and Credentialing Quick Reference Guide
This quick reference guide highlights differences among the contracting, enrollment, and credentialing processes required to become a network provider.
Dr. Jud Brewer’s Hunger Habit workshop available on demand
Access the recorded version of Dr. Jud Brewer’s Hunger Habit workshop on the Boston University Center for Continuing Education website until April 22, 2025.
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 and coverage, updated MNGs, and more.
Upcoming training opportunities
We invite you to register for one of our many interactive training sessions during the month of July.
Coordination of Benefits Quick Reference Guide
This Quick Reference Guide offers providers tips on how to determine which plans have the primary obligation to provide benefits.
Durable medical equipment updates
Point32Health is assessing our reimbursement platforms and making updates to better manage coding for DME and the application of regulatory requirements.
Updates to facility ER policy and processing rules
Point32Health will begin reviews of facility ER claims to determine the appropriateness of the E/M level of care submitted.
Language interpretation services reminder
Point32Health offers various language interpretation services for members and their providers, who may need assistance beyond their practice’s resources.
Medication Reconciliation – reminder for primary care providers
Point32Health emphasizes the importance of maintaining a standard medication reconciliation procedure to avoid patient medication errors.
Point32Health Medical Necessity Guideline updates
Providers and office staff can refer to this chart to review changes and updates to Point32Health’s Medical Necessity Guidelines.
Point32Health medical drug program updates
Refer to the information in this chart for details on updates to Point32Health’s medical benefit drug prior authorization programs.
Integrated Point32Health Payment Policy: Clinical Trials
We are introducing an integrated Point32Health Clinical Trials Payment Policy, which outlines information pertaining to Harvard Pilgrim and Tufts Health Plan.
Upcoming training opportunities
We invite you to join one of our many interactive training webinar sessions throughout the month of June — register today!