Insights and Updates for Providers

February 2024

Billing for COVID-19

Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health One Care | Tufts Health Plan Senior Care Options | Tufts Medicare Preferred

Modifier CS should no longer be used and claims with it may deny.

Coverage for services provided by LMFTs/LMHCs

Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health One Care | Tufts Health Plan Senior Care Options | Tufts Medicare Preferred

Effective Jan. 1, 2024, LMFTs and LMHCs will be recognized as Medicare-eligible providers.

Reminder: QMB Members Exempt from Part A/B Cost-Sharing

Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health Plan Senior Care Options | Tufts Medicare Preferred

Reminders for providers regarding Qualified Medicare Beneficiary enrollee exemption from cost-sharing liability.

Model of Care Training

Tufts Health Plan Senior Care Options

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.

2024 Part B Step Therapy program

Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health Plan Senior Care Options | Tufts Health Unify | Tufts Medicare Preferred

New requirements will apply to the 2024 Part B Step Therapy program.

Point32Health billing updates

Tufts Health Medicare Preferred PPO | Tufts Health Plan MCO/ACO | Tufts Health Plan Senior Care Options | Tufts Health Unify | Tufts Medicare Preferred HMO

Point32Health is making updates to our billing requirements for certain products.

MassHealth billing reminders

Tufts Health Plan Senior Care Options | Tufts Health Together | Tufts Health Unify

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.

CMS billing update for home health services using telehealth

Tufts Health Plan Senior Care Options | Tufts Medicare Preferred HMO/PPO

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.

Update to Integra’s DMEPOS network: Senior Products

Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health Plan Senior Care Options | Tufts Medicare Preferred

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.

MassHealth guidance on provider-to-provider e-consults

Tufts Health Plan Senior Care Options | Tufts Health Together - MassHealth MCO Plan and ACPPs | Tufts Health Unify

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.

Reminder of telehealth billing requirements

Tufts Health Plan Senior Care Options | Tufts Health Together | Tufts Health Unify

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.

Changes to ambulatory surgical center payments

Tufts Health Plan Senior Care Options | Tufts Medicare Preferred HMO/PPO

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).