Insights and Updates for Providers

October 2024

New Point32Health webpages to streamline your operations

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

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

Tufts Health Plan Commercial | Tufts Health Public Plans

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

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

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

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

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

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

Point32Health requires prior authorization for coverage of all prenatal testing, including NIPT, which can be requested using the resources provided here.

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.