Please refer to the chart below for information on new and updated Payment Policies. For details, access the policies listed below by visiting the Payment Policies section of our Point32Health provider website.
| Updates to Payment Policies | |||
|---|---|---|---|
| Payment Policy Title | Products Affected | Effective Date | Additional information |
Home Health Care
| Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, Tufts Health One Care, Tufts Health Plan Senior Care Options, Tufts Medicare Preferred | 10/1/2025 | Minor administrative edits for accuracy and clarity. |
| Transplants | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, Tufts Health One Care, Tufts Health Plan Senior Care Options, Tufts Medicare Preferred | 10/1/2025 | Integrated Point32Health Payment Policy replaces the Harvard Pilgrim Health Care Transplant Payment Policy and the Tufts Health Plan Transplant Facility Payment Policy. |
Inpatient Hospital Admissions
| Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, Tufts Health One Care, Tufts Health Plan Senior Care Options, Tufts Medicare Preferred | 10/1/2025 | Minor administrative edits for accuracy and clarity.
|
| Obstetrics/Gynecology | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, Tufts Health One Care, Tufts Health Plan Senior Care Options, Tufts Medicare Preferred | 10/1/2025 | Minor administrative edits for accuracy and clarity.
|
| Radiation Oncology | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, Tufts Health One Care, Tufts Health Plan Senior Care Options, Tufts Medicare Preferred | 10/1/2025 | Minor administrative edits for accuracy and clarity.
|
| Chemotherapy Oncology | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, Tufts Health One Care, Tufts Health Plan Senior Care Options, Tufts Medicare Preferred | 10/1/2025 | Minor administrative edits for accuracy and clarity.
|
| General Coding and Claims Editing | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, Tufts Health One Care, Tufts Health Plan Senior Care Options, Tufts Medicare Preferred | 10/1/2025 | Minor administrative edits for accuracy and clarity.
|
| Radiology | Harvard Pilgrim Health Care Commercial | 10/1/2025 | Minor administrative edits for accuracy and clarity.
|
| Imaging Services | Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, Tufts Health RITogether, Tufts Health One Care, Tufts Health Plan Senior Care Options, Tufts Medicare Preferred | 10/1/2025 | Minor administrative edits for accuracy and clarity.
|
| Inpatient and Intermediate Behavioral Health/Substance Use Disorder Facility | Tufts Health Plan Senior Care Options, Tufts Medicare Preferred | 10/1/2025 | Updates to Billing Instructions section to include information on Administratively Necessary Days (AND) |
| Applied Behavioral Analysis Services | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, Tufts Health RITogether | 10/1/2025 | Policy name changed from Autism Services to Applied Behavioral Analysis Services.
Updates to Billing Guidelines and Documentation section to reflect changes in Medical Necessity Guidelines. Refer to Applied behavioral analysis policy coverage updates article for more information. |