Updates regarding Tufts Health Public Plans claim appeals
We’re updating our rules and requirements associated with appeals submission and timely filing limits for Tufts Health Public Plans claims.
Insights and Updates for Providers
May 2025
Clinical documentation required for radiology services
As of Jan. 1, Point32Health will require clinical documentation for outpatient advanced imaging services for Tufts Health Plan Commercial and Tufts Health Public Plans members.
New Point32Health webpages to streamline your operations
We are announcing a few integrated webpages to streamline the provider experience, including our Prior Authorization, Forms, and Vendor Programs pages.
Electronic corrected claims reminder
As a reminder, corrected claims submissions should not include documentation of previous payment information, as this may delay processing.
Payment Policy update and modifier requirements
We’re introducing a streamlined Point32Health Drugs and Biologicals Payment Policy and will require providers to append modifier JW or JZ, when applicable.
Psychotherapy services billing reminder
When billing for psychotherapy services, use the procedure code that most closely reflects the duration of time spent with the patient during the session.
Prior authorization required for noninvasive prenatal testing
Point32Health requires prior authorization for coverage of all prenatal testing, including NIPT, which can be requested using the resources provided here.
Change Healthcare update: Timely filing limits and claim adjustment requirements to resume
Point32Health will return to our standard requirements for all lines of business regarding timely filing and claim adjustments, effective Sept. 1, 2024.
Coverage reminder – Community Behavioral Health Center services
We would like to remind providers of notification requirements and billing procedures related to Community Behavioral Health Center services.