Change in denial process for lack of prior authorization
We’re making a change to our claim adjudication process for ancillary services billed in connection with services requiring prior authorization when the authorization is not obtained.
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US Family Health Plan transition
We will transition administrative operations of the US Family Health Plan beginning Jan. 1, 2027, sunsetting the Tufts Health Plan Commercial line of business.
Guide to navigating the prior authorization process
We’ve developed a Quick Reference Guide offering an overview of our UM program and the options for submitting and tracking your prior authorization requests.
OTC drug exclusions and other formulary updates
We will no longer provide coverage for drug products that are explicitly over-the-counter or are prescriptions that have OTC equivalents.
In-home KED, FIT, and HbA1c preventive screenings
We’re announcing a new quality initiative focused on in-home preventive screenings for Tufts Health Plan SCO and Tufts Medicare Preferred members.
Reminder: Annual wellness visit covered by calendar year
Tufts Health Plan uses a calendar year (Jan. 1 through Dec. 31) for coverage of annual wellness visits for Senior Products members.
Old Colony Elder Services expands coverage to South Shore
Old Colony Elder Services has expanded its service area to now cover all 34 communities across Plymouth County and the South Shore.
Billing for psychological and neuropsychological testing
Point32Health would like to offer a reminder for our provider partners of the appropriate billing practice for psychological and neuropsychological testing.
Reminders on pain management and opioid antagonists
We want to offer some reminders regarding pain management plans and alternative therapies, as well as coverage and billing of opioid antagonists.
Reminder: One Care training requirement
The online resources in the Training section of our website make it easy for you to comply with One Care training requirements.
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