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.
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.
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.
Providers can refer to the following chart to review updates and changes to our Medical Necessity Guidelines.
Providers can refer to the following chart to review updates and changes to our medical benefit drug program.
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.
Providers and office staff can refer to the following chart to review changes and updates to Point32Health’s Medical Necessity Guidelines.
Providers and office staff can refer to the following chart to review updates to our medical benefit drug program.
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.
Point32Health will update systems and policies to reflect new 2025 CPT and HCPCS codes beginning Jan. 1, 2025.
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.
Our new integrated Point32Health Obstetrics and Gynecology Payment Policy will replace our previous Harvard Pilgrim and Tufts Health Plan policies.
Providers and their office staff can refer to this chart to review changes and updates to the Point32Health Medical Necessity Guidelines.
Providers and their office staff can review the following chart for changes and updates to our coverage program for medical drugs.
We’re modifying the way we accept requests for authorizations, notifications, and referrals across Point32Health, and recommend electronic and fax options for greater efficiency.
Join us on Wednesdays in September for our upcoming Living Well webinar series: Healthy Habits to Get the Most Out of Every Moment.
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.
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.
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.
Point32Health offers many resources, including our Coordination of Care Check List, for providers with patients living with chronic physical and/or mental illness.
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.
Timely follow-up and patient education are key to ensuring effective transition of care interventions and preventing hospital readmissions within 30 days.
When billing for an office visit with more than one service, providers should report all service codes related to the visit on one claim.
We are providing reminders and strategies for improvement on the FUH and IET HEDIS measures to maximize the opportunity for success.
Refer to this chart to review changes and updates to Point32Health’s Medical Necessity Guidelines, information about newly developed MNGs, and more.
Refer to this chart to review changes and updates to Point32Health’s medical drug program, including information about prior authorization, coverage updates, and more.
We encourage providers to use electronic options for a variety of transactions, as the Provider Service Center will be discontinuing its email account.
We annually review our provider network and may terminate providers who have not provided services to our members in the past two years.
To ensure accurate claims processing, claims submitted to Point32Health are subject to regular edits based on regulatory guidelines, medical society recommendations, and more.
When billing our members for services delivered through the Psychiatric Collaborative Model of Care, it’s important to use the procedure codes identified here.
To align with industry standard coding practices, Point32Health is making updates to our General Coding and Claims Editing Payment Policy.
Refer to this chart to review changes and updates to Point32health’s Medical Necessity Guidelines, information about newly developed MNGs, and more.
Refer to this chart to review changes and updates to Point32Health’s medical drug program, including information about prior authorization, coverage updates, and more.