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Network Health

Searchable Drug List Pharmacy Updates

Preferred Drug List changes effective July 1, 2015

  • Products added
  • Products added with quantity limits, step therapy, and prior authorization
  • Prior authorization and quantity limits removed from products

Searchable Drug List Member Care

Antidepressant and attention deficit hyperactivity disorder (ADHD) medication compliance

It’s important for your patients to take their prescribed antidepressant and ADHD medication.

Child and adolescent needs and strengths (CANS) form

The CANS consent form was updated in February 2015. It includes user-friendly language to ensure both the provider and caregiver understand the consent process and explains how the information gathered is stored in a safe place.

Expanding our disease management program

Disease management is our clinical and quality management of chronic conditions, such as asthma and diabetes, and we are expanding it to include another product and other diseases.

Searchable Drug List Profile Spotlight

Spotlight your practice in an upcoming Provider Update!

Every day we meet with providers who are doing exceptional work helping patients and supporting their communities. Tell us what makes your practice stand out and we might highlight your organization in a future issue of Provider Update.

Searchable Drug List What's New

As of May 1, 2015, we’ve added revised or new pharmacy guidelines

We also have a comprehensive list of all our pharmacy medical necessity guidelines.

Payment policy updates, May 1, 2015 – July 31, 2015

We’ve recently posted and/or updated the following payment policies:

Prior authorization updates

We will require additional prior authorization for certain in- and out-of-network outpatient same-day surgeries beginning June 1, 2015. This means if you are requesting for your patient one of the specific outpatient procedures on the list that follows, you will need to request prior authorization from us.

Searchable Drug List Reminders

Adverse Incident Report (AIR) form

We’ve recently updated the Adverse Incident Report (AIR) form. Please be sure to use the updated form on our website.

Key differences between Tufts Health Plan and Tufts Health Plan – Network Health

We have been a division of Tufts Health Plan since 2011. We changed our name from Network Health to Tufts Health Plan – Network Health in October 2014 to better align ourselves.

Long-term services and supports (LTSS) benefits for Tufts Health Unify members

Long-term services and supports enable your patient to live independently in the community.

Provider Preventable Conditions (PPC) and Serious Reportable Events (SREs) Policy

The Centers for Medicare & Medicaid Services (CMS) introduced the Hospital-Acquired-Conditions - Present on Admission (HAC-POA) program for Medicare claim coding in 2008. For discharges occurring after October 1, 2008, hospitals would not receive additional payment for specific conditions that were not present on admission.

Verify member eligibility

Before seeing patients it is important to verify their member eligibility and confirm that you accept their plan.

Provider Update is our quarterly publication of updates relevant to our provider network and serves to amend our Provider Manual.

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