As you may remember from previous communications, as of July 1, 2023, Harvard Pilgrim’s contract with Optum/UBH will expire and our contracted network will provide behavioral health care services for both Tufts Health Plan and Harvard Pilgrim Health Care members. Additionally, we have begun migrating members from Tufts Health Plan Commercial products to Harvard Pilgrim Health Care Commercial products, and this migration will occur on a rolling basis throughout this year and next.
If you are a behavioral health provider with a member who has migrated or is migrating from a Tufts Health Plan to a Harvard Pilgrim Health Care Commercial product prior to July 1, 2023 and you do not currently participate in the Optum/United Behavioral Health (Optum/UBH) network, please contact Optum/UBH at 888-777-4742 to request a single case agreement (SCA) to ensure you can continue to provide care seamlessly for the member.
If the member is migrating prior to July 1, 2023, please contact Optum/UBH at 888-777-4742 to request a single case agreement (SCA) for the member, effective through June 30, 2023.
In addition, please keep the following in mind:
- Ensure that the SCA is effective through June 30, 2023.
- Optum/UBH will back date the effective date of the SCA to the member’s migration date to ensure uninterrupted services for your patient.
- When you receive your SCA packet from Optum/UBH, please confirm that all of the CPT codes for the services you provide are documented accurately. Optum will create Continuity of Care authorizations based on this coding and will match those authorizations to the SCA to ensure appropriate claims payment.
- Failure to complete the SCA will result in claims for services for these Harvard Pilgrim members being denied.
As a contracted Tufts Health Plan behavioral health provider, you should have received a contract amendment to enable you to provide care for our Harvard Pilgrim members. For most providers, there is nothing to do for this amendment to be effective, unless additional instructions are provided. If you haven’t received this information or have a question about it, please contact Harvard Pilgrim’s Contracting team at AHCBehavioralHealth@point32health.org. For additional information on our integration and migration efforts, please refer to this FAQ.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Jesse Salvato, Stephen Wong