Tufts Health Unify becomes Tufts Health One Care
Effective Jan. 1, 2024, Tufts Health Unify is changing its name to Tufts Health One Care.
Insights and Updates for Providers
October 2023
Enrollment/screening process for Medicaid providers
As a reminder, federal regulations require that providers who render services for Medicaid members are screened by and enrolled with the appropriate state Medicaid agency.
Telehealth billing reminders and MassHealth guidance
We would like to remind providers to adhere to the billing guidance and requirements identified in MassHealth bulletins 355, 364, and 95. In addition, modifier V3 is no longer available; providers should report modifier 93 to indicate services rendered via audio-only telehealth.
2024 Part B Step Therapy program
Effective for fill dates on or after Jan. 1, 2024, the following coverage requirements will apply to the Part B Step Therapy program for Harvard Pilgrim Stride (HMO)/(HMO-POS) Medicare Advantage, Tufts Medicare Preferred, Senior Care Options, and Tufts Health Unify.
Point32Health billing updates
Point32Health is making some updates to our billing requirements, all of which will be effective Dec. 1, 2023 for all Tufts Health Plan Medicare Advantage and Medicare-Medicaid products.
MassHealth billing reminders
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
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
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
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
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
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
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
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.
Reimbursement update for IEP services effective July 1
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.
Behavioral Health Medical Necessity Guideline updates
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.
Medicaid enrollment/screening deadline
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.
Submitting newborn claims appropriately
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.
Behavioral health performance specifications updated
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.
Billing for telehealth
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.
Enrollment/screening process for Medicaid providers
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.