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.
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.
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.
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.
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.
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.
Harvard Pilgrim is no longer using OncoHealth for radiation oncology medical management for Commercial and Stride members. In an effort to more closely align the provider experience across Point32Health products, we’re also implementing some changes for Tufts Health Plan products.
This chart identifies code updates to Point32Health and National Imaging Associates, Inc.’s (NIA’s) medical necessity review program, which are effective June 1, 2023 and intended to align coverage and criteria for the Harvard Pilgrim and Tufts Health Plan products included in the program.
Read more for helpful updates and reminders to keep in mind this month. Topics include required data elements for coordination of benefits claims, opioid treatment performance specifications, and reminders regarding stretchers and the standard form for chemotherapy prior authorization.
As of April 1, 2023, Harvard Pilgrim’s Commercial and Stride (HMO)/(HMO-POS) Medicare Advantage plans will no longer use OncoHealth for radiation oncology medical management.
Beginning March 1, 2023, AIM Specialty Health (Harvard Pilgrim and Tufts Health Public Plans’ genetic/genomic and molecular diagnostic testing services utilization management vendor) will be known by a new name: Carelon Medical Benefits Management.