Insights and Updates for Providers

April 2024

MNG update: Non-Emergency Medical Transportation

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Integrated Point32Health Medical Necessity Guidelines for Non-Emergency Medical Transportation.

Pharmacy coverage changes

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Pharmacy coverage changes for various Point32Health products.

Reminder: trastuzumab biosimilar strategy

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Reminder of our biosimilar strategy for trastuzumab oncology drugs.

Pharmacy coverage changes

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Pharmacy coverage changes for various Point32Health products.

Expanded access to CGP for advanced solid tumors

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We’re reminding providers of our comprehensive genomic profiling coverage and authorization process.

Point32Health non-emergent ambulance reimbursement

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Integrated Point32Health Ambulance and Transportation Services Payment Policy and reimbursement update.

Pharmacy coverage changes

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Pharmacy coverage changes for various Point32Health products.

Pharmacy program reminders

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Point32Health would like to offer some reminders pertaining to our Pharmacy program.

Pharmacy coverage changes

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Pharmacy coverage changes for various Point32Health products.

Pharmacy coverage changes

Harvard Pilgrim Health Care Commercial | Tufts Health Direct | Tufts Health Plan Commercial | Tufts Health RITogether

Pharmacy coverage changes for various Point32Health products.

Pharmacy program reminders

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Coverage reminders related to our Pharmacy program.

Pharmacy coverage changes

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Jan. 1, 2024 Pharmacy coverage changes for various Point32Health products.

Preferred oncology biosimilars for 2024

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Preferred products for the bevacizumab, rituximab, and trastuzumab drug classes.

Synagis coverage for the 2023-2024 RSV season

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Point32Health would like to remind providers of our Synagis (palivizumab) policy for the 2023-2024 season.

Pharmacy coverage changes

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Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.

Rhode Island professional fee schedule updates

Tufts Health RITogether

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

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

Tufts Health RITogether

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

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Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.

Pharmacy coverage changes

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Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.

Update for acute inpatient facility readmissions

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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

Tufts Health Plan SCO | Tufts Health RITogether | Tufts Health Together | Tufts Health Unify

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

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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.