Complex Care Management services
Point32Health provides complex care management services individually tailored to patients.
Insights and Updates for Providers
April 2024
Provider data, enrollment, and credentialing email address
We’re consolidating email addresses for submission of information to Tufts Health Plan.
Reminder: Psychological testing and TMS
Attach Psychological and Neuropsychological Assessment and/or rTMS form(s) to prior authorization requests.
Crisis resource reminder for Massachusetts members
Learn more about Community Behavioral Health Center resources available in Massachusetts.
Reminder: Redetermination for Medicaid patients
Read about how providers can support members through the Medicaid redetermination process.
Reminder: Public Plans initial paper claims address change
As a reminder, the address for Tufts Health Public Plans initial paper claim submissions changed on Aug. 1, 2023.
Complex Care Management services
Point32Health provides care management services for adult and pediatric members.
Supporting Medicaid patients with redetermination
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
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
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.
Tufts Health Public Plans initial paper claims address change
Please be aware that the address for Tufts Health Public Plans initial paper claim submissions is changing. Starting August 1, 2023, initial paper claims for both Massachusetts and Rhode Island Public Plans should be sent to the address indicated in this article.
NIA vendor program code updates
In the April issue of Insights and Updates for Providers, Point32Health announced a number of changes expected to take effect June 1, 2023 in relation to the medical necessity review and prior authorization program that National Imaging Associates, Inc. (NIA) oversees on our behalf for certain procedures.
Point32Health Medical Necessity Guideline updates
Review this chart for information on updates to Medical Necessity Guidelines (MNGs) associated with Point32Health’s products
Providers and office staff can refer to the following chart to review information on changes and updates to Medical Necessity Guidelines (MNGs) pertaining to the various products under the Point32Health umbrella.