Back to Insights and Updates for ProvidersFebruary 2023

Home infusion claims update

Tufts Health Plan Commercial  |  Tufts Health Plan SCO  |  Tufts Medicare Preferred

Effective for dates of service beginning April 1, 2023, Tufts Health Plan is insourcing claims pricing and processing for home infusion services for Tufts Health Plan Commercial, Tufts Medicare Preferred and Tufts Health Plan Senior Care Options. Tufts Health Plan will apply edits in our processing systems in accordance with our policies and procedures, and industry standard edits. Currently, home infusion claims for the products noted above are submitted to CVS Health-Novologix.

  • For home infusion services with dates of service prior to April 1, 2023:
    Providers may continue to submit these claims to Novologix until June 30, 2023. You will have viewing access with Novologix to check the status of claims through July 1, 2023.
  • For home infusion services with dates of service of April 1, 2023 and beyond:
    Providers should submit these claims to Tufts Health Plan and should bill using industry standard HCPCS codes to ensure claims are processed accurately.

Claims filing limits still apply (typically 60 days after date of service for Medicare claims and 90 days after date of service for Commercial claims).

For the fastest processing, we encourage electronic claims submission; alternatively, you can mail claims directly to Tufts Health Plan at:

Tufts Health Plan Commercial
P.O. Box 178, Canton, MA 02021

Tufts Medicare Preferred or Senior Care Options
P.O. Box 518, Canton, MA 02021

The Tufts Health Plan Home Infusion Payment Policy has been updated to reflect this change.

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