Skilled nursing facilities are required by MassHealth to submit a Status Change Form (SC-1 form) to MassHealth when One Care members are admitted and discharged, as well as to complete the form when a member’s stay extends beyond 6 months. This information allows health plans to effectively plan for the member’s future care needs.
Effective for dates of service beginning Dec. 1, 2023, failure to submit the SC-1 within 120 days of the member’s admission will result in claims for the services rendered to the member being pended and failure to submit the form to MassHealth within 150 days may result in the denial of claims.
To assist SNFs in meeting this requirement, Tufts Health Plan will notify a SNF if MassHealth reports that an SC-1 form has not yet been submitted and a Unify member has been at the SNF for 90 days or more.
We will release any claims that have been pended for adjudication upon confirmation that the SC-1 has been submitted to MassHealth within the deadline and receipt of a copy of the completed SC-1. Please send the completed copy to Tufts Health Plan by email to THP_One_Care_SC-1_Submission@point32health.org or FAX at 857-304-6078.
SNFs should refer to the MassHealth website, as well as the Tufts Health Plan Skilled Nursing Facility Payment Policy, for additional information.
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