Save the date: Point32Health launches on Availity Essentials™ Nov. 16!
Point32Health is launching Availity Essentials, adding new provider self-service tools, electronic transactions, training resources, and other enhancements.
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Reminder: updated Provider Service Center hours
Beginning Nov. 2, Provider Service Center hours change to 8:30 a.m.–noon and 1–4:30 p.m. on weekdays.
Reminder: Complete the new 2026 Model of Care training by Dec. 31!
As we shared in our last two newsletters, the new 2026 SCO Model of Care training is available, and we encourage you to complete it as soon as possible.
Reauthorization requirements for targeted immunomodulators
Certain dermatology patients using targeted immunomodulators must obtain reauthorization beginning Jan. 1, 2027, to maintain coverage.
Claim appeals reminders and required form
Paper claim appeals submitted after Jan. 1, 2027 must include the Universal Provider Request for Claim Review Form.
Outpatient facility fee schedule updates
We’re updating our Harvard Pilgrim outpatient facility fee schedules for rehabilitation hospitals, surgery centers, and skilled nursing facilities.
Reminder: sleep management program enhancements
Point32Health will introduce extensive enhancements to our sleep management program intended to streamline utilization management for sleep studies and sleep DME.
Upcoming Medicaid eligibility and renewal changes
Medicaid members may face more frequent renewals and work requirements; providers should help patients stay informed.
Point32Health Medicare products: 2027 benefit changes
We’re announcing 2027 benefit updates across Tufts Medicare Preferred, SCO, and One Care plans.
Update to Tufts Medicare Preferred PPO offering for 2027
Our current Tufts Medicare Preferred PPO RX plan is ending and will be replaced by a new premium PPO option in 2027.
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