To support prompt processing, efficient claims administration, and timely payment, we are reminding providers to adhere to Point32Health’s standard filing limits when submitting initial claims for services rendered, which vary by product and scenario/type of claim.

We recently updated our online Provider Manuals to offer greater clarity around these filing limits, which are outlined below: 

Harvard Pilgrim Health Care Commercial plans and Tufts Health Public Plans

  • Professional claims (CMS-1500): Submit within 90 days of the date of service.

  • Institutional claims with interim billing: Submit within 90 days of the claim end date.

  • Institutional claims without interim billing: Submit within 90 days of hospital discharge.

Tufts Health Plan Senior Products

  • Professional claims (CMS-1500): Submit within 60 days of the date of service.

  • Institutional claims with interim billing: Submit within 60 days of the claim end date.

  • Institutional claims without interim billing: Submit within 60 days of hospital discharge.

Please keep in mind that claims received by Point32Health after the deadline may be denied, and providers may not bill members for services denied because the filing limit was exceeded.

For detailed information and guidance on claims submission, we encourage you to bookmark the Claims Submission Guidelines chapter of the Harvard Pilgrim Health Care Provider Manual and the Claim Requirements, Coordination of Benefits and Dispute Guidelines section of the Tufts Health Public Plans and Senior Products Provider Manuals.