Insights and Updates for Providers

We’re making a change to our claim adjudication process for ancillary services billed in connection with services requiring prior authorization when the authorization is not obtained.

We want to provide some additional clarity around the timeframe associated with the Home and Community Care Transitions notification requirement for home health care services.

We've reviewed and updated our Payment Policy for Serious Reportable Events and Provider Preventable Conditions for enhanced clarity and to provide various additional state and federal resources.

As a reminder, providers are now required to submit a Medicare opt-out form with their claim in applicable instances.

For dates of service beginning July 1, specialized risk screening for eligible first responders will be covered for Harvard Pilgrim Health Care members.

In support of NCQA and CMS efforts, Point32Health has developed a HEDIS tip sheet offering insight into the Depression Screening and Follow-Up for Adolescents and Adults measure. 

We provide coverage for a number of health care transition services under the Early and Periodic Screening, Diagnosis, and Treatment benefit for Tufts Health RITogether members ages 14-21.

Point32Health encourages our provider partners to schedule patients for annual preventive services and appropriate screenings to help close gaps in care and maximize HEDIS outcomes. 

If you are a Massachusetts Medicaid provider who hasn’t completed enrollment with the state Medicaid program, do so to ensure you can continue to participate in our Medicaid products.

As a reminder, we will no longer cover the specified drugs for the treatment of obesity or overweight for members of certain plans.