Providers who haven’t completed their Electronic Visit Verification are encouraged to complete the process as soon as possible per the Massachusetts Executive Office of Health and Human Services.
MassHealth’s Children’s Behavioral Health Initiative is introducing its new Family-based Intensive Treatment program in September.
Refer to the following chart for information regarding upcoming pharmacy coverage changes.
Effective Aug. 1, 2025, we will no longer authorize observation stays longer than 48 hours for Tufts Health Together, Tufts Health RITogether, and Tufts Health One Care.
Please refer to this chart for information on updates to our Pharmacy coverage and Medical Necessity Guidelines.
Our vendor partner for molecular diagnostic testing, Carelon, is implementing an update effective Aug. 1, 2025 regarding defining its service dates.
Please refer to this chart for information on updates to our Pharmacy coverage and Medical Necessity Guidelines.
Prior authorization is now required for Tufts Health Together members prescribed insulin Aspart, to encourage the use of cost-effective short-acting insulin agents.
We’re reminding providers of MassHealth’s submission deadline for outstanding claims, claims corrections, and claims appeals for services provided between Jan. 1, 2024 and Dec. 31, 2024.
In an effort to consistently apply industry standard claims edits reflecting national correct coding and guidelines from state regulatory agencies, we’re making updates to align our claims editing platforms.
As a reminder, as of April 1 the previously announced continuity of care period has ended and a prior authorization must be obtained for all members starting IMRT prior to their course of treatment.
Please refer to this chart for information on updates to our Pharmacy coverage and Medical Necessity Guidelines.
Please refer to this chart for information on updates to our Pharmacy coverage and Medical Necessity Guidelines.
As of April 1, Point32Health must be notified within one business day following a member’s admission to an inpatient facility.
We’re sharing a reminder regarding continued stay reviews for DRG case rate admissions, and an update to our level of care review process for elective inpatient surgical procedures.
In support of guidance from MassHealth and the Executive Office of Health and Human Services, we will provide an additional add-on payment for corrective mobility system timely repairs.
As a reminder for optometrists and ophthalmologists who treat Tufts Health Together members, routine eye exams should be reported using CPT codes 92002, 92004, 92012, and 92014.
As of Nov. 21, 2024, Point32Health will now cover medically necessary inpatient donor human milk and donor human milk-derived products for members of certain Massachusetts plans.
Effective for dates of service beginning March 1, 2025, Point32Health and Evolent are adding prior authorization requirements for a number of additional cardiac services.
We have made updates to our pharmacy program; please refer to the Pharmacy Medical Necessity Guidelines page on our website for more details.
Tufts Health Together is offering a pilot program to provide in-home and virtual health evaluations to patients, in collaboration with Signify Health.
The following changes to Point32Health’s Pharmacy program take effect on Jan. 1, 2025, including prior authorization, drug status, and formulary updates for various products.
The chart in this article outlines a new medical benefit step therapy program, which will be effective for fill dates on or after Jan. 1, 2025.
Mental health wellness examinations will now be covered annually at no cost to Tufts Health Together members, effective retroactively beginning July 1, 2024.
Capped rental durable medical equipment should be billed with the appropriate capped rental modifier, in accordance with correct coding practices, to ensure reimbursement.
We recently launched our behavioral health service navigation program to provide personalized guidance for patients seeking information regarding telebehavioral health care.