Integrated payment policies and POS code update
Introducing new integrated Point32Health payment policies.
Insights and Updates for Providers
May 2024
New and updated Medical Necessity Guidelines
New and updated Medical Necessity Guidelines for Jan. 1, 2024.
Point32Health’s access to care standards
Access to care policies for Tufts Health Plan and Harvard Pilgrim.
Register for a claims consultation event near you!
Claims consultation events coming in RI, MA, NH, CT, and ME.
Introducing Our Chief Medical Officer Glenn Pomerantz, MD, JD
Point32Health has appointed Glenn Pomerantz, MD, JD as our new Chief Medical Officer.
New HEDIS® tip sheets now available
Point32Health has developed new tip sheets for three HEDIS measures.
BH screening for children and adolescents in the primary care setting
Reminder: it’s important to offer children routine behavioral health screening.
Help us keep directory information up to date
Review and verify the accuracy of demographic data at least quarterly.
Well-child visits and vaccines for adolescents
Learn more about vaccines and screenings recommended annually for patients between ages 12-21.
Pharmacy Coverage Changes
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
Point32Health Medical Necessity Guideline updates
Review changes and updates to Point32Health’s Medical Necessity Guidelines (MNGs), information about newly developed MNGs, and more.
Point32Health medical drug program updates
Review changes and updates to Point32Health’s medical drug program.
Integrated Point32Health payment policies
Point32Health has developed some integrated Point32Health Payment Policies.
Federal waiver requirement to prescribe buprenorphine eliminated
Read about federal changes regarding prescribing buprenorphine and training requirements.
Claims consultation events coming near you!
After the resounding success of the July claims consultation event we hosted at our Canton, MA headquarters, Point32Health is delighted to share that we’re expanding the series beyond Massachusetts and offering events in other states.
Responding to requests for more information
To avoid denials based on missing information needed for Point32Health to conduct a complete prior authorization review, and to avoid delays in patient care, please respond back timely to requests for more information.
Promoting the flu vaccine
The flu season runs from October through April each year, and given the ongoing COVID pandemic, it’s particularly important to emphasize the importance of getting the 2023-2024 flu vaccine to your patients.
Reducing 30-day readmissions
Reducing hospital readmissions within 30 days is a considerable priority in health care, leading to increased patient satisfaction and improved outcomes.
Metabolic monitoring for patients on antipsychotic medications
Patients taking antipsychotic medications are at increased risk of developing health conditions including diabetes, high blood pressure, abnormal cholesterol and triglyceride levels, and obesity. Yearly screening and regular metabolic monitoring is vital for children, adolescents, and adults on these medications.
IET measure — tips to keep in mind
As a follow-up to our July 2023 communication regarding the Initiation and Engagement of Substance Use Disorder Treatment (IET) HEDIS measure, which assesses the follow-up care patients receive after a new episode of substance use disorder (SUD), we’d like to offer some additional tips to keep in mind.
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 (MNGs), information about newly developed MNGs, and more.
New integrated Point32Health payment policies
As part of our overarching integration work as a combined company, Point32Health has developed the following new, integrated Point32Health Payment Policies.
Billing reminder for pelvic floor therapy
As a reminder, Point32Health provides coverage for treatment of pelvic floor disorders. Members are eligible to receive clinical evaluation and physical therapy (PT) as outlined in their plan benefits, and providers should use diagnosis code 090.89 when billing for PT for pelvic floor disorders.
You’re invited: Join us for a personalized claims consultation in Canton
As part of our ongoing commitment to collaborating with our valued provider partners, and building on the success of our July claims consultation, we are hosting another claims consultation in October.
Join us for a provider training
Point32Health’s August webinars offer providers the opportunity to ask questions and share feedback while gaining the latest information on products, processes, systems and more. To register, click the links included in this article.
Cell and gene therapy monitoring
For dates of service beginning Oct. 1, 2023, providers are required to comply with long-term monitoring requirements related to cell and gene therapies, including requests for follow-up clinical data and/or attestation of clinical outcome.
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 (MNGs), information about newly developed MNGs, and more.
Returning to business as usual
In the wake of the cybersecurity incident we identified on April 17, we have returned our core Harvard Pilgrim Health Care systems, business functions, and tools online and wanted to share an overview of recent announcements.
Reminder: join us for a personalized claims consultation
Point32Health is pleased to announce that we will be opening the doors to our Canton office this summer to host providers for claims consultations. The event will be an opportunity for providers to meet with our Provider Relations team, who will be available as a resource to support you by answering questions you may have about claims.
Join us for a provider training
Point32Health’s July webinars offer providers the opportunity to ask questions and share feedback while gaining the latest information on products, processes, systems and more — and registering is easy!
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 (MNGs), information about newly developed MNGs, and more.
Coordination of medical and behavioral health care
At Point32Health, we believe collaboration and communication between primary care physicians and behavioral health care providers are pivotal to quality patient care, helping to minimize adverse medication interactions, allowing for better management of treatment, and improving follow‐up for patients with behavioral health and other medical conditions.
Updates and reminders for FUH and IET HEDIS measures
Point32Health would like to highlight some information and reminders that may help support you in your efforts to adhere to the guidelines and standards of care set forth by the Follow-Up After Hospitalization for Mental Illness (FUH) and Initiation and Engagement of Substance Use Disorder Treatment (IET) HEDIS measures.
Clinical discharge summaries for psychiatric and SUD treatment
As a reminder, psychiatric and substance use disorder treatment facilities are required to submit discharge summaries within 24 hours of member discharge from an inpatient, residential treatment, or partial hospitalization program. This article outlines requirements for Point32Health members.
Screening for depression in the primary care setting
There are several depression screening tools available for use in the primary care setting, which Point32Health recommends as a starting point for diagnosis and coordination of follow-up care, and we also offer helpful resources and information.
System updates for our provider network
We continue our work in restoring our core Harvard Pilgrim Health Care systems and encourage providers and office staff to visit our System Update for Providers FAQ for the latest information.
Join us for a personalized claims consultation
Point32Health is pleased to announce that we will be opening the doors to our Canton office this summer to host providers for claims consultations. The event will be an opportunity for providers to meet with our Provider Relations team, who will be available as a resource to support you by answering questions you may have about claims.
Mindfulness program for providers
Point32Health is pleased to offer our providers access to our Peak Mind Challenge, which features a playlist of twenty brief meditation videos showcasing Dr. Amishi Jha’s mindfulness-based methods to train your attention to improve brain power, mood, and performance.