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System update and abbreviated provider newsletter
A cybersecurity ransomware incident has impacted systems that support Harvard Pilgrim’s Commercial and Stride Medicare Advantage plans. (Refer to our System Update for Providers page for more information.) Due to related complications, this month’s provider newsletter issue is abbreviated. Read more...
COVID-19 coverage updates
President Joe Biden has signed a bill that will officially end the federal COVID-19 Public Health Emergency at the end of the day on May 11, 2023. As a result, Point32Health is returning to many pre-pandemic operations and policies.. Read more...
GIC product updates effective July 1
Effective July 1, 2023, Point32Health is updating our Commercial Group Insurance Commission product offerings, which will include Harvard Pilgrim Quality HMO and Harvard Pilgrim Explorer POS. Read more...
Claims editing alignment
For dates of service beginning July 1, all claims for both medical and behavioral health services, including those performed at community mental health centers, will be subject to claims edits and processed consistently across our claims platforms for the legacy brands. Read more...
FDA withdrawal of Makena
As a result of the FDA’s decision on April 6 to withdraw approval of Makena — both the brand name and generic injection — Point32Health will not authorize any prior authorization requests for new starts for Commercial, Tufts Health Direct, and Tufts Health RITogether members.
Read more...
Removing certain drugs from white-bagging program
Effective for dates of service beginning July 1, 2023, the medications identified in this article will no longer be offered through CVS Caremark as part of Tufts Health Plan’s office-administered medical drug/white bagging program. Read more...
Reimbursement update for IEP services effective July 1
Effective for dates of service beginning July 1, 2023, Point32Health will no longer provide reimbursement for claims submitted with modifiers TM and TR for services provided in conjunction with a student’s individualized education program. Read more...
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