Insights and Updates for Providers

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.

We’re implementing a new requirement that all contracted ABA providers must obtain accreditation from a nationally recognized accrediting body specializing in ABA.

We’re offering a reminder of formulary updates for Oct. 1, and an update regarding a Nov. 15 formulary status change for SGLT2 inhibitors.

As a reminder, MassHealth members will now have their care covered under the MassHealth fee-for-service program instead of a health plan. 

We encourage you to utilize the electronic self-service options on our secure provider portals for ease of use and quick turnaround times. 

Tufts Health Plan Senior Care Options (SCO) PCPs and specialists are reminded to complete the new 2025 SCO Model of training by the end of 2025. 

With the flu season approaching, providers are reminded that they play a vital role in informing patients and addressing misconceptions about vaccination efficacy.

For non-emergent clinical triage, our mobile integrated health vendor partner, instED, may be able to help.

Yearly screening and ongoing metabolic monitoring are integral to the management of antipsychotics for children, adolescents, and adults.

Point32Health has interpretation services for hundreds of languages that can assist providers with communication for non-English-speaking patients.