Pharmacy coverage changes
Pharmacy coverage changes for various Point32Health products.
Pharmacy coverage changes for various Point32Health products.
We’re reminding providers of our comprehensive genomic profiling coverage and authorization process.
Complete screening and enrollment to continue participating in Tufts Health RITogether.
Use code A4287, not K1005, for coverage of breast milk storage bags.
Integrated Point32Health Ambulance and Transportation Services Payment Policy and reimbursement update.
Pharmacy coverage changes for various Point32Health products.
Adalimumab biosimilars added to the Tufts Health RITogether pharmacy formulary.
Complete Rhode Island Medicaid screening and enrollment prior to Feb. 1, 2024.
Ovia Health now available to Tufts Health Together and Tufts Health RITogether members.
Point32Health would like to offer some reminders pertaining to our Pharmacy program.
Pharmacy coverage changes for various Point32Health products.
Pharmacy coverage changes for various Point32Health products.
Coverage reminders related to our Pharmacy program.
Jan. 1, 2024 Pharmacy coverage changes for various Point32Health products.
Preferred products for the bevacizumab, rituximab, and trastuzumab drug classes.
Providers who render services for Medicaid members must be screened by and enrolled with the appropriate state Medicaid agency.
For Tufts Health RITogether members, providers will soon have more electronic portal functionality than ever before.
Point32Health would like to remind providers of our Synagis (palivizumab) policy for the 2023-2024 season.
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
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.
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.
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.
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
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.
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.
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.
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.
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.
Our comprehensive genomic profiling coverage, offered through FMI, has expanded.
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.
Please refer to this chart to review updates to pharmacy prior authorization programs applicable to Harvard Pilgrim Health Care and Tufts Health Plan products.
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.
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.