Insights and Updates for Providers

October 2023

Telehealth billing reminders and MassHealth guidance

Tufts Health Plan SCO  |  Tufts Health Together  |  Tufts Health Unify

We would like to remind providers to adhere to the billing guidance and requirements identified in MassHealth bulletins 355, 364, and 95. In addition, modifier V3 is no longer available; providers should report modifier 93 to indicate services rendered via audio-only telehealth.

Billing for specialized Community Support Program services

Tufts Health Plan SCO  |  Tufts Health Together  |  Tufts Health Unify

This article provides an overview of MassHealth’s Community Support Program (CSP) Services, available to members of the Tufts Health Plan Together, Tufts Health Unify, and Tufts Health Plan Senior Care Options products, as well as information about billing and notification requirements.

Reminder: P.O. Box changes for referral forms

Tufts Health Plan Commercial  |  Tufts Health Plan SCO  |  Tufts Medicare Preferred HMO  |  US Family Health Plan (USFHP)

Tufts Health Plan encourages electronic submission of referrals for greater convenience and a real-time receipt of a referral number. Alternatively, providers may submit outpatient referrals using paper referral forms to the updated mailing addresses identified in this article.

JZ modifier now required

Tufts Health Plan SCO  |  Tufts Medicare Preferred

In accordance with Centers for Medicare and Medicaid Services (CMS) policy, for dates of service on or after July 1, 2023, Point32Health now requires providers to append modifier JW or JZ when reporting a drug from a single-dose vial or package.

Standard annual eligibility review process returning

Tufts Health Plan SCO  |  Tufts Health RITogether  |  Tufts Health Together  |  Tufts Health Unify

Because the annual renewal process for Medicaid members has resumed, over the next year all Medicaid members will need to have their eligibility re-determined. Please remind your Medicaid patients to complete the renewal process.

Home infusion claims update

Harvard Pilgrim Health Care Commercial  |  Tufts Health Plan SCO  |  Tufts Medicare Preferred

As previously communicated and effective for dates of service beginning April 1, 2023, Tufts Health Plan is insourcing claims pricing and processing for home infusion services for Tufts Health Plan Commercial, Tufts Medicare Preferred and Tufts Health Plan Senior Care Options.

Medicaid enrollment/screening deadline

Tufts Health Plan SCO  |  Tufts Health RITogether  |  Tufts Health Together  |  Tufts Health Unify

Federal regulations require that providers who serve Medicaid members — including those who participate in Tufts Health RITogether, Tufts Health Together – MassHealth MCO Plan and Accountable Care Partnership Plans, Tufts Health Senior Care Options, and Tufts Health Unify — are screened by and enrolled with the appropriate state Medicaid agency.

Behavioral health performance specifications updated

Tufts Health Plan SCO  |  Tufts Health Together  |  Tufts Health Unify

As part of our ongoing review of performance specifications, we revised the behavioral health performance specifications identified in this article, applicable to certain Tufts Health Plan products, effective April 1, 2023.

Billing for telehealth

Tufts Health Plan SCO  |  Tufts Health Together  |  Tufts Health Unify

Tufts Health Plan is making some updates to our payment policies related to the submission of professional claims for services provided via telehealth, and also reprocessing certain previously denied claims to be reimbursed, in accordance with MassHealth’s MCE Bulletin 95.

Updates and reminders

Tufts Health Plan SCO  |  Tufts Health Public Plans  |  Tufts Medicare Preferred

Read more for helpful updates and reminders to keep in mind this month. Topics include required data elements for coordination of benefits claims, opioid treatment performance specifications, and reminders regarding stretchers and the standard form for chemotherapy prior authorization.

Home infusion claims update

Tufts Health Plan Commercial  |  Tufts Health Plan SCO  |  Tufts Medicare Preferred

Effective for dates of service beginning April 1, 2023, Tufts Health Plan is insourcing claims pricing and processing for home infusion services for Tufts Health Plan Commercial, Tufts Medicare Preferred and Tufts Health Plan Senior Care Options.

Acute behavioral health services for Tufts Health Plan

Tufts Health Direct  |  Tufts Health Plan MA Commercial products  |  Tufts Health Plan SCO  |  Tufts Health Together  |  Tufts Health Unify

Tufts Health Plan has updated the notification requirement for acute behavioral health services updated from two to three business days for Tufts Health Plan Massachusetts Commercial products, Tufts Health Together, Tufts Health Unify and Tufts Health SCO.