As a reminder, effective for dates of service beginning Dec. 1, 2026, Point32Health will introduce extensive enhancements to our sleep management program intended to streamline utilization management for sleep studies and sleep DME (e.g., positive airway pressure [PAP] devices, PAP supply/resupply) across multiple lines of business. 

Updates include:

  • EviCore — our current sleep benefit management vendor for Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, and Tufts Medicare Preferred — will assume management of prior authorization for sleep‑related services for Harvard Pilgrim Health Care Commercial and Tufts Health RITogether members, replacing the current mix of internal processes and vendor partnerships.
    • EviCore will begin accepting prior authorization requests on November 16, 2026, for dates of service beginning December 1, 2026.
  • The sleep studies program presently administered by Evolent for Harvard Pilgrim Commercial members will be retired in conjunction with this shift to EviCore. 
    • Services such as cardiac diagnostic tests and interventional procedures; high-tech diagnostic imaging; select joint procedures; spine surgery and cervical spine procedures; and outpatient interventional spine pain management services will continue to be reviewed by Evolent.
  • Notification will no longer be required through EviCore for sleep studies and sleep DME for Tufts Medicare Preferred members. 

You can read more about the upcoming enhancements to our sleep management program in this article,  which we published in the October issue of Insights and Updates for Providers.

Training sessions

EviCore will be hosting the following virtual Point32Health Sleep Management Provider Orientation sessions, designed to support providers and their staff in understanding and navigating the new program requirements:

  • Nov. 17, 2026 – 12:00 p.m. – 12:30 p.m. EST
  • Nov. 19, 2026 – 2:00 p.m. – 3:00 p.m. EST
  • Nov. 23, 2026 – 11:00 a.m. – 12:00 p.m. EST
  • Dec. 3, 2026 – 10:00 a.m. – 11:00 a.m. EST
  • Dec. 8, 2026 – 11:00 a.m. – 12:00 p.m. EST
  • Dec. 10, 2026 – 1:00 p.m. – 2:00 p.m. EST

These training opportunities will include an overview of the prior authorization process and information on how to access and use resources on the EviCore website, as well as a live question-and-answer session. 

Advance registration is required for these online orientation sessions, which you can do here. If you are unable to attend the live session, a copy of the presentation and other related materials will be available on EviCore’s Point32Health provider resource site. We encourage you and your office staff to take advantage!