New HEDIS® tip sheets now available
Point32Health has developed new tip sheets for three HEDIS measures.
Insights and Updates for Providers
December 2023
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.
Pharmacy and medical drug authorization reminders
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.
Pharmacy Coverage Changes
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
Point32Health Fraud, Waste, and Abuse Payment Policy
We’ve developed an integrated Point32Health Fraud, Waste, and Abuse Payment Policy, in an effort to offer information pertaining to Harvard Pilgrim Health Care and Tufts Health Plan policies and procedures streamlined in one comprehensive document.
Point32Health medical drug program updates
New and updated medical drug prior authorization programs.
Point32Health medical drug program updates
Review changes and updates to Point32Health’s medical drug program.
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.
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.
Point32Health Medical Necessity Guideline Updates
Medical necessity guideline updates.
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.
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 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.
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.
Point32Health’s access to care standards
Access to care policies for Tufts Health Plan and Harvard Pilgrim.
Preventive services coverage reminders and resources
Harvard Pilgrim and Tufts Health Plan members are entitled to receive full coverage for preventive care services, with no cost-sharing responsibility, when these services are rendered by an in-network provider. Refer to the PPACA/preventive services documentation referenced in this article for more details.