Last updated 09/16/22: Removed previously end dated Medicare Advantage Reimbursement policies; added clarifying information regarding Bivalent boosters

Coronavirus (COVID-19) Updates for Providers

During the COVID-19 Public Health Emergency (PHE), Tufts Health Plan has adapted policies and business operations to support members receiving care and to aid providers in their efforts to provide patients with safe access to the care they need.

As states lift PHE orders, Tufts Health Plan is returning to many pre-pandemic operations and policies. Refer to the resources below for the most up-to-date information about Tufts Health Plan's policies and coverage. For any product not specifically stated within the PHE-related policies outlined below, the pre-pandemic policy applies.

For any policy without an end date listed or for which it states "until further notice," we continue to evaluate Tufts Health Plan policies with the applicable state PHE orders and other regulations in mind, and will aim to provide at least four weeks' notice in advance of any termination of the policy. Coverage and policies for Tufts Health Commercial (including CareLinkSM ), Tufts Health Medicare Preferred HMO, Tufts Health Plan Senior Care Options (SCO), Tufts Health Public Plans (Tufts Health Direct, Tufts Health RITogether, Tufts Health Together – MassHealth MCO Plan and Accountable Care Partnership Plans [ACPPs], and Tufts Health Unify) members, unless otherwise specified, are as follows:

COVID-19 Vaccinations

Tufts Health Plan understands the urgency of getting vaccines administered swiftly and effectively and is committed to supporting providers in this important work.

The federal government has purchased the vaccine and is supplying it to vaccinators. Providers will receive the vaccines from the state and/or federal health agencies.

Tufts Health Plan complies with federal and state guidelines for vaccines, including boosters. With the recent U.S. Food and Drug Administration (FDA) Emergency Use Authorization (EUA) of bivalent formulations of the COVID-19 booster vaccines, individuals aged 12 and older should only be offered the updated (bivalent) mRNA (Pfizer-BioNTech or Moderna) booster. 

Refer to the CDC and applicable Department of Public Health (DPH) for Massachusetts and Rhode Island for information on COVID-19 vaccinations, including primary doses and boosters.

COVID-19 Diagnostic Testing and Treatment

Telehealth/Telemedicine

Referrals and Prior Authorizations

Billing and Reimbursement Guidelines

Pharmacy

More Information

 

*The above applies to all fully-insured and self-insured groups. Self-insured groups do have the option to opt-out of several of these policies but must do so in writing. Because Uniformed Services Family Health Plan (USFHP) is subject to separate federal requirements, the above policies do not apply to USFHP with the exception of the policies regarding COVID-19 Diagnostic Testing and Treatment. Please refer to the USFHP provider portal for information regarding telemedicine billing procedures.

The above policies will be revisited on a continuing basis.

Note: Providers should follow these guidelines for the dates of services listed during the COVID-19 PHE. For all other billing guidelines, refer to the Professional Services and Facilities Payment Policy and the benefit-specific payment policies located in the Provider Resource Center.