Insights and Updates for Providers

June 2024

Care management Medicare role change

Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Medicare Preferred

Point32Health is making adjustments to certain care management functions to better coordinate on transitions of care for our members.

New Massachusetts Behavioral Health Resource Directory

Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Medicare Preferred

The Massachusetts BHHL has launched a resource directory — behavioral health providers are encouraged to confirm their practice is listed.

Pilot program offers in-home urgent care

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

Select Senior Products members can opt into our in-home urgent care program, instED.

Complex Care Management services

Harvard Pilgrim Health Care Commercial | Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health Plan Commercial | Tufts Health Public Plans | Tufts Medicare Preferred

Point32Health provides complex care management services individually tailored to patients.

About Our Chronic Condition Management programs

Harvard Pilgrim Health Care Commercial | Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health Plan Commercial | Tufts Medicare Preferred

Point32Health’s chronic condition management programs reinforce clinician treatment plans.

Point32Health non-emergent ambulance reimbursement

Harvard Pilgrim and Tufts Commercial | Tufts Health Direct | Tufts Health One Care | Tufts Health Plan Commercial | Tufts Health Plan SCO | Tufts Health RITogether | Tufts Health Together | Tufts Medicare Preferred

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

Billing for COVID-19

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

Modifier CS should no longer be used and claims with it may deny.

Coverage for services provided by LMFTs/LMHCs

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

Effective Jan. 1, 2024, LMFTs and LMHCs will be recognized as Medicare-eligible providers.

Reminder: QMB Members Exempt from Part A/B Cost-Sharing

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

Reminders for providers regarding Qualified Medicare Beneficiary enrollee exemption from cost-sharing liability.

Complex Care Management services

Harvard Pilgrim Health Care Commercial | Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health Plan Commercial | Tufts Health Public Plans | Tufts Medicare Preferred

Point32Health provides care management services for adult and pediatric members.

About Our Chronic Condition Management Programs

Harvard Pilgrim Health Care Commercial | Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health Plan Commercial | Tufts Medicare Preferred

Point32Health’s approach to chronic condition management through patient-centered care.

Inform Point32Health if you offer concierge medicine services

Harvard Pilgrim Health Care Commercial | Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health Plan Commercial | Tufts Medicare Preferred

Providers who are planning to offer concierge medicine services to eligible members are required to provide advance notice.

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.

JZ modifier now required

Tufts Health Plan SCO | Tufts Medicare Preferred

In accordance with Centers for Medicare and Medicaid Services (CMS) policy, for dates of service on or after July 1, 2023, Point32Health now requires providers to append modifier JW or JZ when reporting a drug from a single-dose vial or package.

AbleTo virtual behavioral health program expanded

Tufts Health Direct | Tufts Health Together—MCOs | Tufts Medicare Preferred

AbleTo’s personalized therapy program is now available to Tufts Health Direct, Tufts Health Together-MCO, and Tufts Medicare Preferred members, and will continue to be offered to Harvard Pilgrim Health Care commercial and Stride (HMO/HMO-POS) Medicare Advantage members.

Update to Integra’s DMEPOS network: Senior Products

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

Integra will soon begin to assume management of the DMEPOS provider network for Point32Health’s Senior Products, starting on July 1, 2023 for Tufts Medicare Preferred and Tufts Health Plan Senior Care Options, and on Sept. 1, 2023 for Harvard Pilgrim Stride (HMO)(HMO-POS) Medicare Advantage.