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 |
Gastroenterology
| 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 | 11/1/2025 | Integrated Point32Health Payment Policy replaces the Harvard Pilgrim Health Care Gastroenterology Payment Policy and the Tufts Health Plan Gastroenterology Payment Policy. |
| Vision | 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 | 11/1/2025 | Integrated Point32Health Payment Policy replaces the Harvard Pilgrim Health Care Vision Services Payment Policy and the Tufts Health Plan Vision Services Payment Policy. |
Hospital-based Clinic
| Harvard Pilgrim Health Care Commercial | 11/1/2025 | Policy updated to reflect Point32Health branding. |
| Evaluation and Management | Harvard Pilgrim Health Care Commercial | 11/1/2025 | Minor administrative edits for accuracy and clarity. |
| Evaluation and Management | 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 | 11/1/2025 | Minor administrative edits for accuracy and clarity.
|
| Drugs and Biologicals | 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 | 11/1/2025 | Minor administrative edits for accuracy and clarity.
|
| Orthotic and Prosthetic Devices | Harvard Pilgrim Health Care Commercial | 11/1/2025 | Minor administrative edits for accuracy and clarity. |
| Orthotics and Prosthetics | 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 | 11/1/2025 | Minor administrative edits for accuracy and clarity.
|
| Dental Care | Harvard Pilgrim Health Care Commercial | 11/1/2025 | New language added to reflect adherence to state mandates when applicable.
Policy updated to reflect Point32Health branding. |
| Durable Medical Equipment (DME) | Harvard Pilgrim Health Care | 11/1/2025 | Minor administrative edits for accuracy and clarity.
|
| Durable Medical Equipment (DME) and Medical Supplies | 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 | 11/1/2025 | Minor administrative edits for accuracy and clarity.
|
Inpatient and Intermediate/Diversionary Behavioral Health/Substance Use Disorder (BH/SUD) Facility (Public Plans) Inpatient and Intermediate Behavioral Health/Substance Use Disorder Facility (Senior Products) | Tufts Health RITogether, Tufts Health Direct, Tufts Health Together, Tufts Health One Care, Tufts Health Plan Senior Care Options | 11/1/2025 | Updated to include:
See related Billing update and Clinical Stabilization Services articles in this issue. |