Network Savings Programs
We leverage strong, collaborative relationships with more than 51,000 doctors and every hospital in our service area, giving our members broad access to affordable, quality care.
Our Approach to Provider Contracting
As part of our contractual arrangement, we pay care management fees to help network providers achieve our mutual goal of improved health outcomes. The fees support providers’ efforts to eliminate gaps in care, reduce readmissions, and enhance the quality of care.
Outside the service area, we have negotiated with national, third-party administrators to provide access to care at discounted rates. This flexible approach to network design achieves significant savings on out-of-area care while assuring access to quality providers for your employees, regardless of where they live.
Out-of-Network Claims Pricing
Using claim edits and clinical expertise, this program favorably reprices care received out-of-network, within our service area. The program also negotiates discounts in the rare instance where a provider is not contracted with us.
Out-of-Area Network Savings
Through this program, Massachusetts- and Rhode Island-based employers have access to enhanced discounts at over 800,000 doctors and 6,000 hospitals nationwide through our strategic relationship with Cigna. This provides greater access to network-based care and better claims pricing outside the Tufts Health Plan service area.
National Transplant Network
Offers access to a national transplant network at discounted rates. The network uses a rigorous evaluation process and connects our members to clinically superior, cost-effective care.