The Centers for Medicare & Medicaid Services and other regulatory bodies, as well as the federal No Surprises Act of 2021, require health plans to maintain and update data in provider directories — and we rely on providers to review their data and notify us of changes as they happen to ensure that members have access to accurate information.
On at least a quarterly basis, providers should make sure to review and verify the accuracy of their demographic data (including, but not limited to practice location, phone number, hours of operation, ability of each individual provider to accept new patients) displayed in our Harvard Pilgrim Health Care and Tufts Health Plan provider directories. Changes to data should be reported via the CAQH Provider Data Portal (formerly known as CAQH ProView) for those who have implemented it.
If your practice has not yet implemented CAQH, please report changes to demographic data to Harvard Pilgrim and/or Tufts Health Plan by:
- Submitting a Provider Change Form to Harvard Pilgrim’s Provider Processing Center by email at PPC@point32health.org, or;
- Submitting a Medical or Behavioral Health Provider Information Form to firstname.lastname@example.org for Tufts Health Plan commercial or Senior Products or to email@example.com for Tufts Health Public Plans products. (For Rhode Island commercial products, please use the following email box: RIProviderEnrollment@point32health.org.)
(Please keep in mind that if your practice participates in both the Harvard Pilgrim and Tufts Health Plan provider networks, you will need to report demographic data changes to both plans as identified above.)
Failure to review and update demographic information at least quarterly may result in suppression from the Harvard Pilgrim and Tufts Health Plan provider directories until the information is validated. In addition, if Point32Health identifies potentially inaccurate provider information in the directories, we may outreach to your practice to validate or obtain accurate information. If we are unable to obtain a timely response, the provider record may be subject to suppression in the directories until up-to-date information is received.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Susan Panos, Stephen Wong,