We also have a comprehensive list of all our pharmacy medical necessity guidelines.
We’ve recently posted and/or updated the following payment policies:
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.
We’ve recently updated the Adverse Incident Report (AIR) form. Please be sure to use the updated form on our website.
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 enable your patient to live independently in the community.
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.
Before seeing patients it is important to verify their member eligibility and confirm that you accept their plan.