Insights and Updates for Providers

October 2023

Update for acute inpatient facility readmissions

Tufts Health Direct  |  Tufts Health RITogether  |  Tufts Health Together  |  Uncategorized

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.

Point32Health Medical Necessity Guideline updates


Providers and office staff can refer to the following chart to review changes and updates to Point32Health’s Medical Necessity Guidelines (MNGs), information about newly developed MNGs, and more.

Point32Health’s access to care standards


Harvard Pilgrim Health Care and Tufts Health Plan, the brands under the Point32Health umbrella, maintain policies that outline network practitioner standards regarding clinician availability, timeliness of appointments, and telephone accessibility, among other things.

Members’ rights and responsibilities


Please take a moment to review this information on Harvard Pilgrim and Tufts Health Plan’s members’ rights and responsibilities. And because this information may vary among states and product lines, please be sure to read the related pages in the respective provider manuals.