Insights and Updates for Providers

June 2024

2024 Part B Step Therapy program

Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health Plan Senior Care Options | Tufts Health Unify | Tufts Medicare Preferred

New requirements will apply to the 2024 Part B Step Therapy program.

Point32Health billing updates

Tufts Health Medicare Preferred PPO | Tufts Health Plan MCO/ACO | Tufts Health Plan Senior Care Options | Tufts Health Unify | Tufts Medicare Preferred HMO

Point32Health is making updates to our billing requirements for certain products.

MassHealth billing reminders

Tufts Health Plan Senior Care Options | Tufts Health Together | Tufts Health Unify

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.

One Care training requirement and resources for Tufts Health Unify

Tufts Health Unify

We offer convenient training resources in the Tufts Health Unify Provider Trainings section of the Tufts Health Plan provider website, in support of Executive Office of Health and Human Services and CMS requirements that providers complete training on the One Care program.

Billing for specialized Community Support Program services

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

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.

MassHealth guidance on provider-to-provider e-consults

Tufts Health Plan Senior Care Options | Tufts Health Together - MassHealth MCO Plan and ACPPs | Tufts Health Unify

Point32Health has updated our applicable Tufts Health Plan systems, as well as the Tufts Health Plan Evaluation and Management Professional Payment Policy, to reflect MassHealth guidance on coverage of provider-to-provider e-consults.

Reminder of telehealth billing requirements

Tufts Health Plan Senior Care Options | Tufts Health Together | Tufts Health Unify

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.

One Care training requirement and resources for Tufts Health Unify

Tufts Health Unify

We offer convenient training resources in the Tufts Health Unify Provider Trainings section of the Tufts Health Plan provider website, in support of Executive Office of Health and Human Services and CMS requirements that providers complete training on the One Care program.

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.

Code update for injectable drugs

Tufts Health Plan MCO/ACO | Tufts Health Unify

Effective for dates of service beginning Aug. 1, 2023, J-codes for injectable drugs will deny when submitted for Tufts Health Unify and Tufts Health Plan MCO/ACO claims without an accompanying quantity, appropriate National Drug Code (NDC) number, and unit of measurement code.