Insights and Updates for Providers

June 2024

Point32Health non-emergent ambulance reimbursement

Harvard Pilgrim and Tufts Commercial | Tufts Health Direct | Tufts Health One Care | Tufts Health Plan Commercial | Tufts Health Plan SCO | Tufts Health RITogether | Tufts Health Together | Tufts Medicare Preferred

Integrated Point32Health Ambulance and Transportation Services Payment Policy and reimbursement update.

Reminder: Psychological testing and TMS

Harvard Pilgrim and Tufts Commercial | Tufts Health Plan Commercial | Tufts Health Public Plans

Attach Psychological and Neuropsychological Assessment and/or rTMS form(s) to prior authorization requests.

Pharmacy program reminders

Harvard Pilgrim and Tufts Commercial | Tufts Health Direct | Tufts Health Plan Commercial | Tufts Health RITogether | Tufts Health Together

Point32Health would like to offer some reminders pertaining to our Pharmacy program.

Pharmacy program reminders

Harvard Pilgrim and Tufts Commercial | Tufts Health Direct | Tufts Health Plan Commercial | Tufts Health RITogether | Tufts Health Together

Coverage reminders related to our Pharmacy program.

Step Therapy Protocols and Exceptions

Harvard Pilgrim and Tufts Commercial | Tufts Health Direct | Tufts Health Plan Commercial | Tufts Health Plan SCO-Medicaid Only Plans | Tufts Health Together

Learn more about mandatory exceptions in step therapy protocols.

Pharmacy coverage changes

Harvard Pilgrim and Tufts Commercial | Tufts Health Direct | Tufts Health Plan Commercial | Tufts Health RITogether | Tufts Health Together

Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.

Pharmacy coverage changes

Harvard Pilgrim and Tufts Commercial | Tufts Health Direct | Tufts Health Plan Commercial | Tufts Health RITogether

Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.

NIA vendor program code updates

Harvard Pilgrim and Tufts Commercial | Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health Plan Commercial | Tufts Health Public Plans

In the April issue of Insights and Updates for Providers, Point32Health announced a number of changes expected to take effect June 1, 2023 in relation to the medical necessity review and prior authorization program that National Imaging Associates, Inc. (NIA) oversees on our behalf for certain procedures.