Insights and Updates for Providers

With industrywide changes coming in 2027 to CPT coding for maternity care, Point32Health is focusing first on updated billing guidance for antepartum care.

In anticipation of MassHealth’s coming encounter data requirement changes, we’re reminding our provider partners to include key data elements when submitting claims.

We’re applying duplicate billing logic to claims/services submitted multiple times for the same date of service beginning on Oct. 1, 2026.

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.

Effective Oct. 1, 2026, we will no longer cover GLP-1s when used for weight loss for Tufts Health RITogether members. 

We will transition administrative operations of the US Family Health Plan to Brighton Marine, effective Jan. 1, 2027.

We’re pleased to be offering a new virtual musculoskeletal care program to eligible Harvard Pilgrim members in collaboration with Hinge Health.

Behavioral health providers can find everything you need to facilitate care for your patients on Point32Health’s dedicated web pages. 

Communication among medical and behavioral health care providers tending to a shared patient is essential when developing a treatment plan.

Updates to Harvard Pilgrim’s standard home care seasonal influenza vaccine fee schedule will take effect on Oct. 1, 2026.