Point32Health continues to streamline processes and policies for greater alignment of our legacy Harvard Pilgrim Health Care and Tufts Health Plan brands. To that end, we’ve developed the following integrated Point32Health payment policies; as a result, the previous legacy policies have been retired, and the pertinent information can be found on the new integrated versions:
- Early Intervention Payment Policy (Harvard Pilgrim website, Tufts Health Plan website): Replacing the Harvard Pilgrim Early Intervention Payment Policy and Tufts Health Plan Early Intervention Payment Policy, effective Nov. 1, 2023
- Podiatry Payment Policy (Harvard Pilgrim website, Tufts Health Plan website): Replacing the Harvard Pilgrim Podiatry Payment Policy and Tufts Health Plan Professional Podiatry Payment Policy, effective Nov. 1, 2023
- Limited Services Payment Policy (Harvard Pilgrim website, Tufts Health Plan website): Replacing the Harvard Pilgrim Limited Service Provider – Retail Medicine Payment Policy and Tufts Health Plan Limited Services Clinics Payment Policy, effective Nov. 1, 2023. As outlined in the policy, all limited-service providers, including walk-in retail clinics, should bill using place of service (POS) code 17. Claims submitted without POS 17 may be denied.
- Urgent Care Payment Policy (Harvard Pilgrim website, Tufts Health Plan website): Replacing the previous Harvard Pilgrim-only policy and will apply for all Harvard Pilgrim and Tufts Health Plan lines of business, effective Nov. 1, 2023. As a reminder, when billing for urgent care services on a CMS 1500 or 837P claim form, please use place of service code 20 (Urgent Care) in addition to the appropriate procedure code
Please note that alignment of payment policies may or may not affect existing claims processing and/or provider reimbursement; substantial changes to these processes will continue to be communicated with advance notice. In many cases, alignment of payment policies is a matter of merging existing information into one cohesive Point32Health policy, with no change in billing or reimbursement rules or requirements.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Susan Panos, Stephen Wong,