Prior authorization for SNF care effective April 1 for Tufts Health Plan SCO.
Insights and Updates for Providers
Tufts Health Plan SCO providers: complete Model of Care training by Jan. 30.
Modifier CS should no longer be used and claims with it may deny.
Effective Jan. 1, 2024, LMFTs and LMHCs will be recognized as Medicare-eligible providers.
Reminders for providers regarding Qualified Medicare Beneficiary enrollee exemption from cost-sharing liability.
New reimbursement for nursing facility rate add-on codes.
Tufts Health Plan Senior Care Options (SCO) PCPs and high-volume specialists are required by the Commonwealth of Massachusetts and CMS to complete the Annual SCO Model of Care Training by Jan. 30, 2024.
When terminating from network, please identify two alternate available providers.
New requirements will apply to the 2024 Part B Step Therapy program.
Point32Health is making updates to our billing requirements for certain products.
While MassHealth is working to renew member eligibility, there may be several eligibility updates occurring at this time. In MassHealth All Provider Bulletin 372, MassHealth shared important reminders of billing responsibilities and billing for retroactively reinstated members.
In keeping with a bulletin from the Centers for Medicare and Medicaid Services, Point32Health now requires providers to report one of the following remote patient monitoring codes, as applicable, when billing for home health services administered via telehealth to our Tufts Health Medicare Preferred or Tufts Health Plan Senior Care Options members.
Integra will soon begin to assume management of the DMEPOS provider network for Point32Health’s Senior Products, starting on July 1, 2023 for Tufts Medicare Preferred and Tufts Health Plan Senior Care Options, and on Sept. 1, 2023 for Harvard Pilgrim Stride (HMO)(HMO-POS) Medicare Advantage.
Point32Health has updated our applicable Tufts Health Plan systems, as well as the Tufts Health Plan Evaluation and Management Professional Payment Policy, to reflect MassHealth guidance on coverage of provider-to-provider e-consults.
We’re offering some reminders and clarifying information on billing for telehealth services for Tufts Health Plan Senior Care Options, Tufts Health Together, and Tufts Health Unify members.
Effective for dates of service beginning Sept. 1, 2023, CPT code 99070 (supplies and materials provided by the physician or other qualified healthcare professional) will no longer be separately reimbursed for ambulatory surgical centers (ASCs).