Insights and Updates for Providers

July 2024

Coverage reminder – Community Behavioral Health Center services

Harvard Pilgrim Health Care Commercial | Tufts Health Direct | Tufts Health Plan Commercial | Tufts Health Plan Senior Care Options | Tufts Health Public Plans

We would like to remind providers of notification requirements and billing procedures related to Community Behavioral Health Center services.

Complex Care Management services

Harvard Pilgrim Health Care Commercial | Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health Plan Commercial | Tufts Health Public Plans | Tufts Medicare Preferred

Point32Health provides complex care management services individually tailored to patients.

Reminder: Psychological testing and TMS

Harvard Pilgrim and Tufts Commercial | Tufts Health Plan Commercial | Tufts Health Public Plans

Attach Psychological and Neuropsychological Assessment and/or rTMS form(s) to prior authorization requests.

Complex Care Management services

Harvard Pilgrim Health Care Commercial | Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health Plan Commercial | Tufts Health Public Plans | Tufts Medicare Preferred

Point32Health provides care management services for adult and pediatric members.

Supporting Medicaid patients with redetermination

Tufts Health Public Plans

We want to ensure that our Medicaid members are aware that they must take action to have their eligibility redetermined and renew their coverage — and you and your practice play an important role in assisting with these efforts.

Reminder: Public Plans initial paper claims address change

Tufts Health Public Plans

As a reminder, the address for Tufts Health Public Plans initial paper claim submissions changed on August 1, 2023. Initial paper claims for both Massachusetts and Rhode Island Public Plans that were previously sent to P.O. Box addresses in Foothill Ranch, CA, should now be sent to the address identified in this article.

Migration to 2023 InterQual criteria

Harvard Pilgrim Health Care Commercial | Tufts Health Plan Commercial | Tufts Health Public Plans

Point32Health utilizes InterQual criteria for clinical authorization review for a number of services. For the Medical Necessity Guidelines listed here, we will be adopting 2023 InterQual SmartSheets to replace the previous versions currently in use.