The following is a list of helpful updates and reminders to keep in mind this month:
- Required data elements for coordination of benefits claims (Tufts Health Public Plans, Tufts Health SCO, Tufts Medicare Preferred): As a reminder, Tufts health Plan enhanced the processing of Coordination of Benefits (COB) claims submitted via EDI, allowing for electronic COB claims to be accepted and auto adjudicated. Complete and accurate information from the payer is required; for a list of the data elements required, please refer to this article from the December newsletter. Claims submitted without the necessary data elements will be rejected.
- Opioid treatment performance specifications (Tufts Health Together, Tufts Health, Unify, Tufts Health Plan SCO): As part of ongoing review of our performance specifications, we revised our Opioid Treatment Services Performance Specifications in February.
- Stretcher reminder (Tufts Health RITogether): The Rhode Island Executive Office of Health and Human Services (RI EOHHS) recently noted that some providers/facilities may not have the appropriate equipment to accommodate patients and are requesting that transportation providers leave stretchers at the facility for the duration of the patient’s appointment. RI EOHHS reminds providers of the need to comply with Title III of the Americans with Disabilities Act, and notes that transportation providers are not required to leave a stretcher at a provider/facility unless it is the member’s personal mobility device and doing so may prevent the transportation provider from attending to other stretcher-bound transportations that day.
- Standard form for chemotherapy prior authorization reminder (All Tufts Health Plan products): As of Feb. 23, 2023, Tufts Health Plan only accepts the Massachusetts Standard Form for Chemotherapy and Supportive Care Prior Authorization Requests. Any previous versions of the form will not be accepted.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Jesse Salvato, Stephen Wong