Insights and Updates for Providers

June 2024

Removal of prior authorization requirements for certain procedures

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We are removing prior authorization requirements from certain procedures and associated codes in a continued effort to administratively simplify providers’ experience.

Pharmacy coverage changes

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Read about updates to Point32Health’s Pharmacy program and our Pharmacy Medical Necessity Guidelines for Harvard Pilgrim and Tufts Health Plan.

Reminder: required billing for telehealth services

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Please keep required billing practices for telehealth services in mind.

Pharmacy coverage changes

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Pharmacy coverage changes for various Point32Health products.

MNG update: Non-Emergency Medical Transportation

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Integrated Point32Health Medical Necessity Guidelines for Non-Emergency Medical Transportation.

Complex Care Management services

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Point32Health provides complex care management services individually tailored to patients.

About Our Chronic Condition Management programs

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Point32Health’s chronic condition management programs reinforce clinician treatment plans.

Pharmacy coverage changes

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Pharmacy coverage changes for various Point32Health products.

Reminder: trastuzumab biosimilar strategy

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Reminder of our biosimilar strategy for trastuzumab oncology drugs.

Billing for lead screening

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Lead screenings for ages 0-6 years covered with no member cost share.

Pharmacy coverage changes

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Pharmacy coverage changes for various Point32Health products.

Expanded access to CGP for advanced solid tumors

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We’re reminding providers of our comprehensive genomic profiling coverage and authorization process.

Pharmacy coverage changes

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Pharmacy coverage changes for various Point32Health products.

Important tips to minimize denials

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Tips for a smooth Harvard Pilgrim commercial migration process and accurate claims reimbursement.

Pharmacy coverage changes

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Pharmacy coverage changes for various Point32Health products.

Connecticut market exit reminder

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Reminder about Harvard Pilgrim Health Care’s withdrawal of fully insured commercial products in Connecticut as of Jan. 1, 2024.

Maine mandates and new coverage

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Commercial medical necessity guideline updates to align with recent legislation in Maine.

Pharmacy coverage changes

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Pharmacy coverage changes for various Point32Health products.

New ICD-10 code for HIV PrEP

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HIV PrEP billing requirements and new ICD-10 code.

Pharmacy coverage changes

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Jan. 1, 2024 Pharmacy coverage changes for various Point32Health products.

Preferred oncology biosimilars for 2024

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Preferred products for the bevacizumab, rituximab, and trastuzumab drug classes.

Other 2024 Pharmacy program updates

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2024 Pharmacy updates: Harvard Pilgrim commercial, Tufts commercial, Tufts Health Direct.

Complex Care Management services

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Point32Health provides care management services for adult and pediatric members.

About Our Chronic Condition Management Programs

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Point32Health’s approach to chronic condition management through patient-centered care.