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Tufts Health Together providers: join our MassHealth Health Equity committee!
Billing update for providers of Specialized Community Support Program Services
We’re reminding providers of our comprehensive genomic profiling coverage and authorization process.
Integrated Point32Health Ambulance and Transportation Services Payment Policy and reimbursement update.
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.
Coverage reminders related to our Pharmacy program.
Preferred products for the bevacizumab, rituximab, and trastuzumab drug classes.
Flovent HFA and Flovent Diskus discontinuing and other coverage updates.
Reminders on adhering to billing requirements identified in MassHealth bulletins 355, 364, and 95.
Providers who render services for Medicaid members must be screened by and enrolled with the appropriate state Medicaid agency.
Learn more about mandatory exceptions in step therapy protocols.
Brand name Flovent HFA and Flovent Diskus will be discontinued at the end of 2023.
While MassHealth is working to renew member eligibility, there may be several eligibility updates occurring at this time. In MassHealth All Provider Bulletin 372, MassHealth shared important reminders of billing responsibilities and billing for retroactively reinstated members.
This article provides an overview of MassHealth’s Community Support Program (CSP) Services, available to members of the Tufts Health Plan Together, Tufts Health Unify, and Tufts Health Plan Senior Care Options products, as well as information about billing and notification requirements.
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
We’re sharing some updates regarding medical benefit drug coverage and the MassHealth Unified Formulary, which will apply for Tufts Health Together beginning July 31, 2023.
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.
We’re offering some reminders and clarifying information on billing for telehealth services for Tufts Health Plan Senior Care Options, Tufts Health Together, and Tufts Health Unify members.
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.
Tufts Health Together–MassHealth MCO Plan and ACPPs now utilize MassHealth’s Unified Formulary for pharmacy medications and for select medical benefit drugs. Effective June 5, 2023, these updates regarding medical drugs and the MassHealth Unified Formulary will apply,
Review this chart for updated Pharmacy Medical Necessity Guidelines with changes effective August 1, 2023 for Point32Health’s Pharmacy drug prior authorization program.
Effective for dates of service beginning July 1, 2023, Point32Health will no longer provide reimbursement for claims submitted with modifiers TM and TR for services provided in conjunction with a student’s individualized education program.
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.
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.
As a reminder, MassHealth All Provider Bulletin 305 explains billing practices for newborn children of all MassHealth members and applies to Tufts Health Together and Unify plans. These guidelines require that providers bill for newborn services separately and not under the mother’s member ID number.
As part of our ongoing review of performance specifications, we revised the behavioral health performance specifications identified in this article, applicable to certain Tufts Health Plan products, effective April 1, 2023.
While Tufts Health Together will be adopting MassHealth’s Unified Formulary on April 1 for Tufts Health Together, we will follow different thresholds for opioid dosage and will be implementing a number of opioid clinical programs as part of the Unified Formulary.
Our comprehensive genomic profiling coverage, offered through FMI, has expanded.
Tufts Health Plan is making some updates to our payment policies related to the submission of professional claims for services provided via telehealth, and also reprocessing certain previously denied claims to be reimbursed, in accordance with MassHealth’s MCE Bulletin 95.
Effective April 1, 2023, Tufts Health Together–MassHealth MCO Plan and ACPPs, in conjunction with the other Medicaid managed care organizations (MCOs) in the Commonwealth, will be utilizing MassHealth’s Unified Formulary for pharmacy medications and for select medical benefit drugs.
Effective April 1, 2023, Tufts Health Together–MassHealth MCO Plan and ACPPs will be utilizing MassHealth’s Unified Formulary for pharmacy medications and for select medical benefit drugs, and pharmacy coverage and criteria for Tufts Health Together consequently will mirror that of MassHealth.
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.
Tufts Health Plan has updated the notification requirement for acute behavioral health services updated from two to three business days for Tufts Health Plan Massachusetts Commercial products, Tufts Health Together, Tufts Health Unify and Tufts Health SCO.