New portal functionality for Tufts Health RITogether
Point32Health is pleased to share that for our Tufts Health RITogether members, providers will soon have more electronic functionality than ever before.
Insights and Updates for Providers
October 2023
Enrollment/screening process for Medicaid providers
As a reminder, federal regulations require that providers who render services for Medicaid members are screened by and enrolled with the appropriate state Medicaid agency.
Synagis coverage for the 2023-2024 RSV season
Point32Health would like to remind providers of our policy regarding Synagis (palivizumab), an injection of antibodies used to protect high-risk infants from severe respiratory syncytial virus (RSV) disease, for the 2023-2024 season.
Pharmacy coverage changes
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
Rhode Island professional fee schedule updates
Beginning Oct. 1, 2023, Point32Health will be updating the Rhode Island Medicaid professional fee schedule we use to determine claims reimbursement for services rendered to Tufts Health RITogether members.
Behavioral Health and substance use disorder tools and resources
Tufts Health RITogether providers have access to several behavioral health and substance use disorder resources. You’ll find information on behavioral health coverage, prior authorization and notification for behavioral health services, resources such as our Provider Manual, and more on the Tufts Health RITogether behavioral health webpage.
Claims filing requirement for court-ordered service
For RITogether members, Tufts Health Plan will not require prior authorization for claims for court-ordered mental health/substance abuse services, for dates of service beginning July 1, 2023.
Pharmacy coverage changes
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
Pharmacy coverage changes
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
Update for acute inpatient facility readmissions
Please be aware that for dates of service beginning Sept. 1, 2023, the readmission policies for DRG facilities for Tufts Health Direct, Tufts Health Together, and Tufts Health RITogether will be expanded to apply to providers reimbursed at a case rate.
Standard annual eligibility review process returning
Because the annual renewal process for Medicaid members has resumed, over the next year all Medicaid members will need to have their eligibility re-determined. Please remind your Medicaid patients to complete the renewal process.
Behavioral Health Medical Necessity Guideline updates
We’re updating our Medical Necessity Guidelines for the behavioral health services Transcranial Magnetic Stimulation, Psychological Testing and Assessment, and Neuropsychological Testing and Assessment, effective for dates of service beginning July 1, 2023.
Coverage updates for breastfeeding equipment and supplies
As of Jan. 1, 2023, Point32Health provides coverage for breastfeeding supplies including storage bags for breast milk (HCPCS code K1005) for certain products, with a quantity limit of 300 bags per three-month reimbursement period.
Medicaid enrollment/screening deadline
Federal regulations require that providers who serve Medicaid members — including those who participate in Tufts Health RITogether, Tufts Health Together – MassHealth MCO Plan and Accountable Care Partnership Plans, Tufts Health Senior Care Options, and Tufts Health Unify — are screened by and enrolled with the appropriate state Medicaid agency.
Expanded access to CGP for advanced solid tumors
Our comprehensive genomic profiling coverage, offered through FMI, has expanded.
Enrollment/screening process for Medicaid providers
Federal regulations require that providers who render services for Medicaid members are screened by and enrolled with the appropriate state Medicaid agency. If you have not yet completed this enrollment/screening process for your applicable patients, please do so.
Pharmacy coverage changes
Please refer to this chart to review updates to pharmacy prior authorization programs applicable to Harvard Pilgrim Health Care and Tufts Health Plan products.
Pediatric services rate increase
In accordance with recent action by the Rhode Island Executive Office of Health and Human Services, Tufts Health Plan is issuing a rate increase retroactive for dates of service on or after July 1, 2022 for certain pediatric claims for Tufts Health RITogether.
Personal care services rate increase
In alignment with a rate increase implemented by the Rhode Island Executive Office of Health and Human Services, Tufts Health Plan will automatically reprocess any claims submitted for personal care services between July 1, 2022 and Jan. 25, 2023.