As part of our integration work as a combined company, Point32Health continuously reviews and assesses payment policies for each of our legacy organizations (Harvard Pilgrim Health Care and Tufts Health Plan), and aligns them wherever possible for greater ease and efficiency.
Please note that this alignment of payment policies may or may not affect existing claims processing and/or provider reimbursement; substantial changes to these processes as a result of alignment efforts will continue to be communicated via provider channels and 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.
In connection with this integration work, we’ve developed the following integrated Point32Health Payment Policies:
- Emergency Department Services (Harvard Pilgrim website, Tufts Health Plan website): This aligned Point32Health policy outlines the relevant information from the now-archived Harvard Pilgrim Emergency Care Payment Policy and Tufts Health Plan Emergency Department Services Payment Policy.
- Dermatology (Harvard Pilgrim website, Tufts Health Plan website): This policy is replacing the previous Harvard Pilgrim Dermatology Payment Policy and Tufts Health Plan Dermatology Professional Payment Policy, which we have archived, and the relevant information from those policies can now be found on this aligned Point32Health version.
- Radiation Oncology (Harvard Pilgrim website, Tufts Health Plan website): This Point32Health policy is replacing the Harvard Pilgrim Radiation Oncology Payment Policy and Tufts Health Plan Radiation Oncology Payment Policy
- Chemotherapy Oncology (Harvard Pilgrim website, Tufts Health Plan website): This policy is replacing the Harvard Pilgrim Oncology and Chemotherapy Payment Policy and Tufts Health Plan Oncology Payment Policy
We’ve also replaced the previous Harvard Pilgrim Nutritional Counseling Payment Policy and Tufts Health Plan Nutritional Counseling Professional Payment Policy with a new, integrated Point32Health Nutritional Counseling Payment Policy.
As a reminder, it’s important for medical nutrition therapy services to be reported correctly based upon who is rendering them. As supported by the American Medical Association, CPT code ranges 97802-97804 or G0270-G0271 should only be reported by a medical nutritionist, nutritional professional, or hospital. If a physician or other qualified health care professional provides medical nutrition therapy, an evaluation and management or preventive service code should be selected.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Susan Panos, Stephen Wong,