Some of our plans require referrals from the member’s PCP for specialty care. As a reminder, if a service that requires a referral is rendered without one being submitted, Point32Health will deny the claim. 

Before providing care, specialists should verify which services require a referral or check the status of an existing referral request. To verify whether a service requires a referral, please check the member’s plan and benefit information or contact the Provider Service Center. 

You may submit referrals in the following ways:

  • Harvard Pilgrim Commercial: Submit electronically using HPHConnect and EDI options (such as NEHEN) or by completing the Harvard Pilgrim Health Care Referral Form and faxing it to 607-509-4297.
  • Tufts Health Plan Senior Products: Submit electronically via the secure portal or by completing the paper referral form and faxing it to 617-972-1028. You can obtain these forms by ordering them through W.B. Mason.
  • Tufts Health Public Plans: Referrals are required for Tufts Health Together members to see a contracted specialist outside their ACO network. Refer to this section of the Public Plans Provider Manual for details and contact Provider Services at 888-2571985 for assistance. 

You may check the status of an existing referral using our secure portals. For details on how to conduct a referral inquiry in our secure portals, please refer to our HPHConnect Submitting Physician Referrals User Guide and Quick Reference Sheet for Harvard Pilgrim members and our Referral User Guide and the Tufts Health Plan Secure Provider Portal User Guide for Tufts Health Plan members. 

For additional information on referrals, please refer to the referral chapters of our online Provider Manuals.