Insights and Updates for Providers

Harvard Pilgrim will not proceed with previously announced prior authorization and level of care reviews for elective inpatient admissions; please continue following existing processes.

A postcard we’re mailing in March will guide providers to key Point32Health resources, portals, and contacts, supporting NCQA requirements and simplifying daily practice needs.

Point32Health now offers in‑home bone density screenings for eligible female SCO members to support osteoporosis detection, treatment planning, and senior independence.

Optum Specialty Pharmacy is no longer filling fertility prescriptions. Fuze Health is now the dispensing pharmacy for the fertility medications.

Tufts Health Plan will adopt CMS/Medicaid MUE limits, apply custom limits when needed, and deny claims exceeding allowable units beginning May 2026.

In alignment with MassHealth, we will require CHCs and FQHCs to append TH modifiers to all CNM and OB/GYN T1015 visits starting Nov. 1, 2025.

USPSTF recommends offering breastfeeding support and referrals, highlighting benefits, skill development, and resources to help mothers during and after pregnancy.

Point32Health informs members and clinicians of rights and responsibilities annually. Refer to the relevant Provider Manuals for detailed information.

Point32Health reminds providers of free interpretation services, offering phone, video, and TTY support to help communicate with non‑English‑speaking patients.

Providers must complete two One Care training tracks, including required webinars and attestation, using Point32Health’s online resources to meet EOHHS/CMS requirements.