Watertown Office Managers Meeting (also available via livestream)

February 22, 2018

Discussion Topics

Product Overviews

Plan Identification

Provider Resource Center

Provider Website Navigation

Referrals, Prior Authorizations and Inpatient Notifications

Online Tools for Providers

Claim Information

Online Claim Adjustments

Provider News and Training

Division and Product Organization To optimize use of our online resources, you must identify and select the Tufts Health Plan division in which the member is enrolled: • Commercial • Medicare • Tufts Health Plan Senior Care Options (SCO) • Tufts Health Public Plans

Refer to the Products Overview and Member ID Card Guide for assistance in determining the member’s plan and the division under which the plan falls.

Tiered Network Plans

A tiered plan is one in which providers are grouped into member cost-share levels, or tiers.

The grouping is based on quality and cost, with the lowest member cost share being applied to those providers who best meet quality and cost-efficiency thresholds.

Member cost share varies by tier, with Tier 1 requiring the smallest member cost share.

For all plans, copayment, coinsurance and deductibles vary by employer group plan design.

Note: Confirm member responsibility using the Eligibility and Benefits search tool on the secure Provider website.

Tufts Health Plan’s Tiered Plans Tufts Health Plan offers a variety of plans with tiered member cost share.

Your Choice

• 3-tier

• 2-tier

Navigator by Tufts Health PlanTM

Massachusetts Group Insurance Commission (GIC) Plans

• Navigator by Tufts Health PlanTM

• Tufts Health Plan Spirit

Steward Employee Choice

Lifespan Premier Choice

Tufts Health Freedom Plan

Note: Tiering methodology differs by plan type.

Lifespan Premier Choice Tufts Health Plan, in collaboration with Lifespan, offers

Lifespan Premier Choice.

Lifespan Premier Choice HMO and PPO are tiered products.

To support providers’ existing practice and referral patterns, providers are tiered at the integrated provider level.

• Physicians and hospitals within the same contracted provider system are placed within the same tier.

Plan Features • Available only to Rhode Island employer groups

• Member cost incentives for using Lifespan providers

• In-network access to Tufts Health Plan network providers

Tufts Health Freedom Plan is an innovative joint venture between Granite Health and Tufts Health Plan.

Product offerings include a diverse suite of tiered and nontiered health plans for New Hampshire employers.

Providers from the Granite Health systems along with providers contracted with Tufts Health Plan in NH, MA and RI make up the Tufts Health Freedom Plan network.

Tufts Health Freedom Plan and Tufts Health Plan Commercial Plans

Commercial providers may see Tufts Health Freedom Plan members. Tufts Health Freedom Plan members will have a Tufts Health Freedom Plan member ID card, and Tufts Health Plan Commercial members will have a Tufts Health Plan member ID card.

Reminder: Use Tufts Health Plan's secure Provider website to verify member eligibility, determine the member's plan type and access benefit information: tuftshealthplan.com/provider.

Limited Network Plans

A limited-network plan provides access to a network that is a subset of Tufts Health Plan’s standard network.

These plans require that members receive all nonemergent covered services from providers who participate in the network specified by their particular plan type.

Limited-network plans are designed to help lower costs while still providing the benefits and services that members need.

Tufts Health Plan Spirit

Tufts Health Plan Spirit is offered to GIC members only.

This plan offers the same in-network benefit coverage and provider tiering as Navigator by Tufts Health PlanTM

.

• There are no out-of-network benefits.

• PCPs are not required.

• Referrals for specialty care are not required.

Members are required to receive all nonemergent covered services from providers who are contracted for and participate in the Tufts Health Plan Spirit Network.

• Nonemergent services outside of the Tufts Health Plan Spirit Network are not covered.

Electronic eligibility inquiries will identify Tufts Health Plan Spirit members.

Select Network Plans

Select Network plans are HMO-based. • Members of Select Network plans must choose a PCP who

participates in the Select Network. • PCP referrals are required. • PCPs must refer members to providers within the Select

Network.

Members are required to receive all covered nonemergent services from providers who are contracted for and participating in the Select Network.

• Nonemergent services outside of the Select Network are not covered.

• In rare cases when a medically necessary service is not available within the Select Network, an IPA reviewer or Tufts Health Plan authorization will be required.

Electronic eligibility inquiries will identify Select Network members.

CareLinkSM Plan Design

Together, Tufts Health Plan and Cigna offer CareLink, a national health plan that gives multistate employers the ability to offer consistent coverage to all of their employees.

Depending on the particular plan design, either Tufts Health Plan or Cigna will be designated as the primary administrator.

The primary administrator performs most plan administrative functions for the employer group, including claims payment.

For shared-administration plans, Tufts Health Plan, Cigna and the union office share administrative functions.

Members can be identified by the CareLink logo on their member ID cards. Eligibility verification can be preformed on Tufts Health Plan’s secure Provider website.

Working with CareLinkSM

Member ID Cards for Senior Products Plans

Tufts Medicare Preferred HMO plans and the Tufts Health Plan Senior Care Options (SCO) Plan earned a 5 out of 5 star rating from Medicare for the third year in a row!

This rating is a reflection of how well Tufts Health Plan supports its members and their health needs.

Navigating Tufts Health Plan’s Website tuftshealthplan.com/provider Tufts Health Plan’s Provider website has two distinct sections:

Public Provider website • Medical necessity guidelines • Payment policies • Pharmacy programs • Provider manuals • Training and education

Secure Provider website (registration required)

1. Tufts Health Provider Connect (Tufts Health Public Plans only)

2. Tufts Health Plan Provider Portal (Commercial and Senior Products)

• Claims status inquiry

• Eligibility and benefits

• Referral inquiry and submission

• Inpatient notification request submission

• Online claim adjustments (now available for Senior Products)

Select a Division

To find the information that you need, identify which division of

Tufts Health Plan your patient’s plan is listed under.

Tufts Health Plan Commercial plans, Tufts Medicare Preferred

HMO, Tufts Health Plan SCO and Tufts Health Public Plans

require separate provider agreements

Accept patients with plans that are listed in the divisions with

which you hold provider agreements.

Always verify member eligibility.

• Check the member’s ID card to determine the member’s plan.

• Use the secure Provider website to verify the member’s plan.

Recommended Browsers

Tufts Health Plan recommends using the latest versions of one of the following

Internet browsers for the public and secure Provider websites:

Mozilla Firefox

Google Chrome

Internet Explorer is not optimal for working on the public and secure Provider websites.

Secure Provider Website Login - Select a Division

NEW Secure Provider Website for Commercial and Senior Products

Eligibility & Benefits Search

Eligibility Search Results

Eligibility Search Results (cont’d)

Benefits Search Results

Benefits Search Results (cont’d)

Claims Tools

Claims Search

Claims Results

Claims Details

Claims Results

Claims Results

Corrected Claims

Corrected Claims

Corrected Claims Details

Disputing Claims

Returning Funds

Referrals

Referral Submission

Referral Submission

Referral Inquiry

Referral Search

Referral Results

Referral Details

NEW Secure Provider Website For Commercial and Senior Products

Authorization Inquiry

Search options:

1. Provider and date range

2. Authorization number

3. Member ID number

4. Member first name, last name

and date of birth

Tufts Health Public Plans

Tufts Health Public Plans provide access to high-quality health care for Massachusetts and Rhode Island residents with low to moderate incomes.

Plan offerings include: Tufts Health Direct – Health Connector (A focused network plan for

individuals and small groups)

Tufts Health Together – Includes Mass Health Plan, as well as the following Accountable Care Partnership Plans (Effective 3/1/18):

Tufts Health Together with Atrius Health

Tufts Health Together with BIDCO

Tufts Health Together with Boston Children’s ACO

Tufts Health Together with CHA

Tufts Health RITogether – A RI Medicaid Plan (serving RIte Care and Rhody Health Partners members)

Tufts Health Unify – OneCare Plan (Medicare-Medicaid plan)

Blue stripe indicates a Tufts Health Public Plans product.

Tufts Health Public Plans Member ID Cards

Plan type

Blue stripe indicates a Tufts Health Public Plans product.

Tufts Health Public Plans ACO Member ID Cards

ACO Logo

Tufts Health Public Plans ACOs

March 1, 2018 is the effective date for all new ACO health plans.

Each ACO plan has unique features and special programs.

March 1, 2018 through May 31, 2018 is the plan selection period. During this period, members can:

• Choose to change health plans during this period.

• Change plans for any reason.

Note: All changes would go through Mass Health.

After May 31, 2018, the fixed enrollment period begins. • Members can only switch plans in the case of a qualifying event.

Tufts Health RITogether

Tufts Health RITogether, our Rhode Island Medicaid plan, provides health insurance to eligible members of the state of Rhode Island.

A separate provider agreement is needed for participation in the Tufts Health RITogether provider network.

Tufts Health Provider Connect Tufts Health Provider Connect offers online self-service tools for Tufts

Health Public Plans products.

Tufts Health Public Plans products include Tufts Health Direct, Tufts Health RITogether, Tufts Health Together and Tufts Health Unify.

Provider Resource Center - Payment Policies

Authorization Policy

Medical Necessity Guidelines

Medical necessity guidelines are established and based on current literature review, including InterQual; consultation with practicing physicians in the Tufts Health Plan service area, who are medical experts in the particular field; the policies of government agencies, such as the U.S. Food and Drug Administration (FDA); and standards adopted by national accreditation organizations.

Guidelines are revised and updated annually, or more frequently as new evidence becomes available that suggests needed revisions.

Medical necessity guidelines and InterQual criteria are used in conjunction with the member’s benefit plan document and in coordination with the provider recommending the service, drug, device or supply.

Medical Necessity Guidelines

Find Pharmacy Information on the Provider Website

Current information regarding tier changes, online formularies and descriptions of pharmacy management programs is available on the Pharmacy section at tuftshealthplan.com/provider/pharmacy.

Tufts Health Public Plans 2018 Preferred Drug Lists

Find Pharmacy Information on the Provider Website

Note: To avoid delays for your patients, providers must complete and sign the standard form, and must also include all relevant supporting documentation with the request. Incomplete, blank or unsigned forms cannot be accepted.

Inpatient Notification

As a condition of payment, Tufts Health Plan requires notification for any member who is being admitted for inpatient care, regardless of whether Tufts Health Plan is the member’s primary or secondary coverage.

Inpatient notification is required for all medical and behavioral health inpatient services.

Inpatient notification is the responsibility of admitting providers and hospital admitting departments.

Inpatient notification does not take the place of a referral or prior authorization requirements for a service.

For a complete description of Tufts Health Plan’s Commercial inpatient notification requirements, refer to the Authorization chapter within the Tufts Health Plan Commercial Provider Manual.

Inpatient Notification Requirements

Admitting providers and hospital admitting departments share the responsibility for notifying Tufts Health Plan in accordance with the following timelines:

Elective admissions: Notify Tufts Health Plan five business days prior to admission.

Emergency/urgent admissions: Notify Tufts Health Plan within the next business day.

Providers can submit an inpatient notification by:

Logging in to the secure Provider website, available at tuftshealthplan.com/provider

EDI transaction; Batch 278 Inpatient Notification files are accepted.

Faxing an Inpatient Notification Form to the Precertification Operations Department at 617.972.9590 or 800.843.3553

Provider Payment Dispute Overview

Providers have the right to file a payment dispute if they disagree with a decision regarding the denial or compensation of a claim.

The Online Claim Adjustment Tool on the secure Provider website is the primary means of submitting Commercial and Senior Products claim adjustment request and payment disputes.

When submitting a payment dispute by mail, the Request for Claim Review Form, along with any supporting documentation, is required. The form can be found in the Forms section of the Resource Center at tuftshealthplan.com/provider.

A separate dispute form must be submitted for each claim adjustment.

All incomplete submissions will be returned.

For complete information, refer to the Provider Payment Dispute Policy found in the Payment Policy section of the Resource Center on the public Provider website.

Submitting Payment Disputes By Mail

A separate Request for Claim Review Form, along with any supporting documentation, is required for each claim adjustment.

Do not include new/original (i.e., previously unprocessed) claims with your payment dispute forms.

Payment disputes must be separated by product and denial reason, and sent to the appropriate post office box.

Do not highlight, as text may appear blacked out when scanned, which may delay processing.

Make sure to list a valid claim number and message code (if applicable) and indicate the appropriate review type.

Appeals for denials resulting from the billing of an unlisted procedure code must include operative notes that identify the service(s) performed associated with the unlisted code. The portion of the operative notes that identifies the unlisted service must be underlined.

Disputes of claims denied for receipt past the filing deadline must include acceptable proof of timely submission.

Tips

Use the “Find a Doctor” search to find out what tier you are on, and if you participate in a particular network.

Use the “Search” function on the Provider News page to locate articles based on key words in article titles.

Use the “Search” field in the Provider Resource Center to narrow your search results for guidelines, forms, payment policies, Provider Manuals and other helpful business documents.

Administrative Updates and 60-Day Notifications*

*As published in the February 1, 2018 issue of Provider Update

Infertility Services: MA and RI Products

Effective for dates of service on or after April 1, 2018, Tufts Health Plan will update the general limitations regarding the use of medications and substances known to negatively affect fertility.

This change applies to Commercial products and is documented in the medical necessity guidelines for Infertility Services for both Massachusetts and Rhode Island products.

Note: This change does not apply to Tufts Health Freedom Plan.

Lower Limb Prosthetic Devices (Including Microprocessor Controlled Knee)

Tufts Health Plan will no longer routinely cover the Genium® X2 microprocessor controlled knee prosthetic device or the Genium X3 waterproof microprocessor controlled knee prosthetic device.

This change will be added to the Limitations section of the Medical Necessity Guidelines for Lower Limb Prosthetic Devices (Including Microprocessor Controlled Knee).

Hyperbaric Oxygen Therapy

Tufts Health Plan will add inflammatory bowel disease (Crohn’s disease; ulcerative colitis) to the Limitations section of the Medical Necessity Guidelines for Hyperbaric Oxygen Therapy Treatment.

Hereditary Retinal Disorders

Tufts Health Plan requires prior authorization for CPT code 81434 (hereditary retinal disorders [e.g., retinitis pigmentosa, leber congenital amaurosis, cone-rod dystrophy], genomic sequence analysis panel, must include sequencing of at least 15 genes, including ABCA4, CNGA1, CRB1, EYS, PDE6A, PDE6B, PRPF31, PRPH2, RDH12, RHO, RP1, RP2, RPE65, RPGR and USH2A).

This change is documented in the Medical Necessity Guidelines for Genetic and Molecular Diagnostic Testing.

Noncovered Investigational Services

The following have been added to the Medical Necessity Guidelines for Noncovered Investigational Services:

Cervical, thoracic and lumbar discography (62290, 62291, 72285, 72295). – 60 Day Notification

Microsurgery for lymphedema – 60-Day Notification

Fecal calprotectin in assay for monitoring Crohn’s disease (calprotectin, fecal: test includes stool calprotectin level reported in mcg/g)

Percutaneous transcatheter coil embolization for pelvic congestion syndrome

Comprehensive brain malformations panel (GeneDX)

Neurodevelopment — Expanded (Ambry Genetics®)

genTrue (True Health Diagnostics)

Color Hereditary Cancer Test

PAULA’s Test (Protein Assays Utilizing Lung Cancer Analytes; Genesys BioLabs) for early detection of lung cancer

Drugs Moving to Noncovered Status

Tufts Health Plan will no longer routinely cover the following medications, as there are drugs with interchangeable generics or therapeutic alternatives available:

• Auryxia®

• Cardura® XL

• Doryx® MPC

• FenorthoTM

• Fosrenol® powder packets

• Phoslyra®

• PrudoxinTM

• Renagel®

• Retin-A Micro® 0.08% gel

• Velphoro®

• Zonalon®

For a member to continue taking any of the above medications, the prescribing provider must request coverage through the medical review process.

Tier Changes

All Commercial Formularies:

Tufts Health Plan will move:

Lexiva® 700mg tablets and dihydroergotamine nasal spray to Tier 3

Almotriptan tablets to Tier 2, for its Commercial formularies

3-Tier Commercial Formularies:

Tufts Health Plan will move Zavesca® to Tier 3 for all its 3-tier Commercial formularies.

Seasonal Flu Advisory

Generic oseltamivir Moving to Tier 2 Due to an intense flu season, Tufts Health Plan has moved

generic oseltamivir from Tier 3 to Tier 2 for members of Tufts Medicare Preferred HMO products.

Read the full article in the Provider News section on Tufts Health Plan’s public Provider

website.

Seasonal Flu Vaccine

The Advisory Committee of Immunization Practices (ACIP) recommends universal seasonal flu vaccination for anyone age six months and older.

Seasonal flu vaccination should begin as soon as the vaccine is available and continue throughout the flu season.

Administration of the seasonal flu vaccine is covered for members of Tufts Health Plan Commercial (including Tufts Health Freedom Plan), Tufts Medicare Preferred HMO and Tufts Health Plan Senior Care Options plans.

For most plans, there is no cost to the member, and copayment and deductible do not apply. If a member pays out of pocket for the flu vaccine, he or she can submit for reimbursement from Tufts Health Plan.

Effective for fill dates on or after April 1, 2018, Tufts Health Plan will no longer cover the following medications, as there are drugs with interchangeable generics or therapeutic alternatives available:

Large Group Pharmacy Changes

• Amerge® • Axert® • Cafergot® • Cardura® • Copaxone® • Frova® • Imitrex® • Istalol® ophthalmic solution 0.5% • Jalyn® • Maxalt® • Maxalt-MLT®

• Migranal® • PhosLo® • Relpax® • Renvela® • Sarafem® • Strattera® • Tamiflu® oral suspension • Uroxatral® • Vagifem® • Zomig® tablets • Zomig-ZMT® tablets

This change applies to large group Commercial formularies only, as these medications were previously moved to noncovered status for small groups.

Hepatitis C Medications

The following changes apply to Commercial products (including Tufts Health Freedom Plan). Effective for new prescriptions filled on or after January 1, 2018, Tufts

Health Plan covers: • Epclusa® (sofosbuvir/velpatasvir) • Harvoni® (ledipasvir/sofosbuvir) • Vosevi® (sofosbuvir/velpatasvir/voxilaprevir) for the treatment of

hepatitis C.

Effective for fill dates on or after January 1, 2018, Tufts Health Plan no longer routinely covers Sovaldi® (sofosbuvir) or Viekira Pak/XRTM (dasabuvir/ombitasvir/paritaprevir/ritonavir).

For a member to initiate a new course of treatment on one of these medications, the prescribing provider must request coverage through the medical review process subject to the Pharmacy Medical Necessity Guidelines for Noncovered Drugs With Suggested Alternatives.

Hepatitis C Medications for Senior Products

Effective for fill dates on or after January 1, 2018, Tufts Health Plan covers the medications listed below for the treatment of hepatitis C for Tufts Medicare Preferred HMO, Tufts Medicare Preferred PDP and Tufts Health Plan Senior Care Options (SCO).

There is no preferred drug. Providers should follow current American Association for the Study of Liver Diseases (AASLD) guidelines when prescribing the medications below for the treatment of hepatitis C:

Drug Tufts Medicare Preferred HMO Individual and Tufts Health Plan SCO

Tufts Medicare Preferred HMO Employer Groups and

PDP

Epclusa® T5 PA T3 PA

Harvoni® T5 PA T3 PA

Mavyret™ T5 PA T3 PA

Sovaldi® T5 PA T3 PA

Vosevi® T5 PA T3 PA

Zepatier® T5 PA T3 PA

Claim Edits for Commercial and Senior Products Effective April 1

Tufts Health Plan will implement the following claim edits for Commercial (including Tufts Health Freedom Plan), Tufts Medicare Preferred HMO and Tufts Health Plan Senior Care Options (SCO)

• Pulmonary • Orthopedics • Ob-gyn • ICD-10 • Durable medical equipment • Evaluation and management • Drugs and biologicals • Outpatient • Laboratory • Radiology • Ophthalmology • Podiatry

These edits are documented in the applicable Commercial, Tufts Medicare Preferred HMO and Tufts Health Plan SCO payment policies.

Claim Edits for Senior Products Effective April 1

Ambulance Tufts Health Plan will implement additional claim edits for ambulance

services. These edits are documented in the Tufts Medicare Preferred HMO/Tufts Health Plan SCO Emergency Ambulance and Transportation, and the Nonemergency Ambulance and Transportation payment policies.

Cardiology Tufts Health Plan will implement additional claim edits for cardiology

services.

These edits are documented in the Tufts Medicare Preferred HMO/Tufts Health Plan SCO Cardiology Services Professional Payment Policy.

Precertification Fax Number Changes for Tufts Health Plan SCO

Effective for dates of submission on or after May 1, 2018, Tufts Health Plan will change the fax numbers used to submit inpatient notifications and outpatient prior authorization requests for Tufts Health Plan Senior Care Options (SCO) members to the following:

Inpatient Notifications: 617.673.0705 Outpatient Prior Authorizations: 617.673.0955 To ensure that your requests are processed, please be sure to use the

correct fax number when submitting requests for coverage for Tufts Health Plan SCO members.

Note: As of May 1, 2018, any inpatient notification request faxed to the incorrect fax number will be returned to the submitting provider/facility. These returned requests must be resubmitted to the correct fax number within one business day following the return of the incorrectly faxed inpatient notification, or the event may be subject to a late notification penalty.

Reminder: Submitting Prior Authorization Requests to Tufts Health Plan

As previously communicated, Tufts Health Plan now accepts the following standard forms for pharmacy prior authorization requests: • New Hampshire Uniform Prior Authorization Form for Prescription Drug Requests • Standard Form for Hepatitis C Medication Prior Authorization Requests • Standard Form for Synagis Prior Authorization Requests • Massachusetts Standard Form for Medication Prior Authorization Requests

Prior to submitting these standard forms to Tufts Health Plan, providers should refer to: • Tufts Health Plan’s coverage policies and pharmacy medical necessity guidelines • The Commercial Pharmacy Medication Prior Authorization Submission Guide to determine

which form to use based on the state and product

• Member benefits and cost-share amounts on Tufts Health Plan’s secure Provider website or other self-service channels, even for members seen on a regular basis

Coverage policies, pharmacy medical necessity guidelines and standard forms are available in the Provider Resource Center on both the Tufts Health Plan and the Tufts Health Freedom Plan public Provider websites.

Reminder: Submitting Prior Authorization Requests to Tufts Health Plan (cont’d)

Tufts Health Freedom Plan Only As previously communicated and effective for dates of submission on or after January 1, 2018, Tufts Health Plan now accepts only the New Hampshire Uniform Prior Authorization Form for Prescription Drug Requests for members of Tufts Health Freedom Plan products. This change applies to members of fully insured Tufts Health Freedom Plan products only, regardless of the member’s state of residence or whether services are rendered in MA, RI or NH. Note: Prescription drugs are defined by the New Hampshire Insurance Department (NHID) as any drug dispensed by prescription only from a pharmacy directly to the consumer.

USFHP Plan Changes

Tufts Health Plan is the third-party administrator for US Family Health Plan (USFHP), a TRICARE program serving eligible military families in southern New England. The recent changes to the larger TRICARE system that are applicable to USFHP are:

• Change in plan year: January 1 through December 31 (Note: As a result of this change, some referrals for benefits tied to the plan year, e.g., physical therapy, occupational therapy, may need to be renewed.)

• Increased copayments for some military retirees USFHP will continue to operate independently of the regional TRICARE

contractors, despite changes to the TRICARE regions and contractors that occurred in January 2018.

US Family Health Plan Billing Information

When billing services for US Family Health Plan (USFHP) members, providers are reminded not to bill Medicare for services covered by USFHP.

Medicare may be billed only for services not covered by USFHP, e.g., end-stage renal disease. For such instances, Medicare should be billed first, followed by USFHP. For a list of services covered by USFHP, refer to the TRICARE Guidelines.

USFHP cannot compensate for claims that have been billed to and compensated by Medicare. Providers must first reimburse Medicare for any previous payment made in error, and must then bill USFHP for compensation of those services.

Any private health insurance, with the exception of Medicare Supplement plans, should be billed prior to billing USFHP.

• This includes federal and state employee insurances.

Providers are reminded to check the member’s ID card to identify USFHP members.

For questions, contact Provider Services at 800.818.8589.

New Medicare Diabetes Prevention Program

Effective for dates of service on or after April 1, 2018, Tufts Health Plan will cover Medicare Diabetes Prevention Program (MDPP) services without coinsurance, copayment or deductible, for eligible members of Tufts Medicare Preferred HMO, Tufts Health Plan Senior Care Options (SCO) and Tufts Health Plan Medicare Supplement plans.

While you may not offer these CDC-approved MDPP services in your practice, you may have patients who are eligible for and who may benefit from the MDPP. The MDPP helps members with a prediabetes diagnosis prevent the progression to type 2 diabetes. The program educates members on how to eat healthy, manage stress, increase physical activity and develop skills to maintain weight loss and a healthy lifestyle.

For questions about MDPP certification and becoming a recognized organization, as well as information about the MDPP, including member eligibility criteria and program exclusions, refer to the CMS website.

HCAS: Multipayer Directory Communication Letter

The Centers for Medicare & Medicaid Services (CMS), MassHealth, the National Committee for Quality Assurance (NCQA) and provisions of the Affordable Care Act (ACA) include requirements that health plans engage providers in reviewing and maintaining up-to-date provider directory information. The regulations are designed to ensure health care consumers have accurate provider demographic information when accessing health care services.

Read the full HCAS Multipayer Directory Communication Letter in the News section at tuftshealthplan.com/news.

Update Your Practice Information

Providers are reminded to notify Tufts Health Plan of any changes to their contact or panel information, such as a change to their ability to accept new patients, a change of street address or phone number, or any other change that affects their availability to patients.

How to Update Your Information Commercial (including Tufts Health Freedom Plan products), Tufts

Medicare Preferred HMO and Tufts Health Plan SCO Providers

If your contact/panel information is not correct on the Find a Doctor search, please update it as soon as possible by completing the Standardized Provider Information Change Form or Tufts Health Plan’s Provider Information Change Form, available in the Provider Forms section of the Resource Center, and returning it by fax or mail, as noted on the form.

Tufts Health Public Plans Providers

If your contact/panel information is not correct on the Find a Doctor search, please update it as soon as possible by completing the Provider Information Form for Medical Providers or for Behavioral Health Providers, available in the Provider Forms section of the Resource Center, and returning it by fax or mail, as noted on the form.

View changes that apply to Commercial products.

Provider Update - tuftshealthplan.com/provider/news

Register to Receive Provider Update by Email

The registration form can be accessed on the public Provider website at tuftshealthplan.com/provider. Click "Register Your Email" below to complete and submit the short registration form.

Note: This email address will be used only for required notifications and other pertinent business communications. It will not change or grant login credentials to the secure Provider website.

Improving Coordination of Care - Managing Care Among Different Providers

Schedule specialist appointments for the patient during or right after the PCP office visit.

Make specialist appointments easier by: • Referring to specialists who offer timely appointments

• Setting clinical expectations with specialists

• Making sure records and reports are available to the specialist before the patient’s appointment

• Referring to specialists who readily send back reports

Establish clear expectations and standards with specialists to exchange reports in a timely manor.

Visit the Institute for Health Care Improvement website at ihi.org/resources for tools, improvement measure guides, white papers and videos that offer help with improvement efforts.

Behavioral Health Provider Diversity

Tufts Health Plan’s Behavioral Health Department has developed a diversity survey in response to member requests to accommodate certain needs and preferences of members with diverse backgrounds.

Provider Resource Guides

Provider Training and Education - tuftshealthplan.com/provider/training

Contact Information

Provider Education: provider_education@tufts-health.com

EDI Operations: 888.880.8699 ext. 54042 or EDI_Operations@tufts-health.com

Technical Inquiries: 888.884.2404, option 6 or network_tech@tufts-health.com

Commercial and Senior Products Behavioral Health Department: 800.208.9565

Commercial and Senior Products Provider Information and Credentialing: 888.306.6307

Provider Call Centers

• Tufts Health Plan Commercial Provider Services: 888.884.2404

• Tufts Health Public Plans Provider Services (MA): 888.257.1985

• Tufts Health Public Plans Provider Services (RI): 844.301.4093

• Tufts Health Plan Medicare Preferred and Tufts Health Plan SCO Provider Relations: 800.279.9022

Hearing Impaired (TDD) Line: 800.861.9022