Last updated 9/9/2021: Continuing to waive COVID-19 treatment cost share for Rhode Island Commercial members through October 2, 2021 due to the extension of the Rhode Island State of Emergency

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 ensuring patients can safely access the care they need. Tufts Health Plan continues to monitor and follow recommendations from the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), State Public Health Departments (Connecticut, New Hampshire, Massachusetts and Rhode Island) and other official sources on an ongoing basis.

As states lift emergency orders, Tufts Health Plan is returning to pre-COVID-19 operations and policies. This page contains the most up-to-date information about Tufts Health Plan's policies and coverage for all fully-insured and self-insured groups*, however, self-insured groups do have the option to opt-out of several of these policies during the PHE and those opt outs may not be specifically listed. As the PHE continues to develop, updates will be posted here. Please check back regularly.

Please note, the information posted here, including member cost sharing changes, may differ from what is reflected in the secure Provider portal. Refer to the Claims Guidelines section for additional information.

Effective Dates

Unless otherwise noted, all policies are effective beginning with dates of service on or after March 6, 2020. These policies have been put in place in connection with the COVID-19 crisis and are not intended to be permanent changes. 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 state emergencies and other regulations in mind, and will aim to provide at least four week notice in advance of any termination of the policy. Coverage and policies for Tufts Health Commercial (including Tufts Health Freedom Plan and 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, Testing and Treatment

Telehealth/Telemedicine

Referrals and Out-of-Network Authorizations

Utilization Management

Claims and Billing Guidelines

Pharmacy

Credentialing

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 Treatment and Inpatient Notification Flexibility. 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 emergency. 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.