Back to Insights and Updates for ProvidersOctober 2023

Tips for avoiding unnecessary denials


CareLink is a national open-access PPO plan that provides both in and out-of-network benefits. CareLink members have access to the Tufts Health Plan provider network in Massachusetts and Rhode Island, and the Cigna provider network in other states.

We are committed to ensuring that providers have an optimal experience when submitting claims for CareLink members. Through ongoing monitoring and review, we’ve compiled a list of reminders to help avoid common unnecessary claim denials and rejections:

  • When providing care to CareLink members, follow Tufts Health Plan payment policies and medical necessity guidelines. You can access our policies in the Resource Center of the Tufts Health Plan website.
  • Use the appropriate NPI number when submitting claims. If a claim denies because the wrong provider information was included, send a corrected claim with the appropriate provider information. Do not submit an appeal.
  • Inappropriate use of modifiers may impact your reimbursement or cause the claim to deny. For example: using both modifiers TC and 26 is considered unbundling. Refer to the Modifiers Payment Policy for more information on applying modifiers appropriately.
  • It is inappropriate to report a diagnostic mammography on the same date of service as a digital breast tomosynthesis. Refer to the Imaging Services Payment Policy for more information.
  • Anesthesia claims are reimbursed in whole unit increments. Each 15-minute interval is converted to one time unit, rounding up to next unit for 8-14 minutes and rounding down for 1-7 minutes. Refer to the Anesthesia Professional Payment Policy for more information.

To learn more about CareLink, access the CareLink section of our Provider Manual.

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Senior Manager, Provider Communications

Joseph O’Riordan, Susan Panos, Stephen Wong,

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Graphic Designer