Frequently Asked Questions

Behavioral health benefits include both behavioral health and substance use disorder treatment.

Find answers to the most frequently asked questions about our behavioral health benefits below.

Do I need to obtain an authorization for behavioral health outpatient therapy?

Either you or your behavioral health provider need to notify Tufts Health Plan within 30 days of your first appointment. It is, however, your behavioral health provider’s responsibility to verify that notification has occurred. To notify Tufts Health Plan of your first visit, call our Behavioral Health Department at 800-208-9565 and choose one of the following two options:

  1. Follow the prompts to access our Behavioral Health Interactive Voice Response system (IVR).

    You will need to provide:

    • Your Tufts Health Plan ID number, including the suffix
    • Your date of birth
    • Your Behavioral Health provider’s 10-digit National Provider Identifier (NPI). A provider’s NPI can be found on the Tufts Health Plan website under “Find a Doctor”, or can be obtained through your provider
    • The start date of your 1st appointment

    You will receive a confirmation number that begins with the letter “V” that you should bring to your 1st appointment.

    or

  2. Follow the prompts to speak directly with a service coordinator who will assist you.
Can initial notifications of treatment be backdated?
Initial notifications of treatment can be backdated for up to thirty days after the initial date of service.
How long is a request for behavioral health treatment in effect?
Notifications are valid for 12 months from the start date or until the number of visits have been exhausted.
How do I receive additional visits after my initial notification?
It is the responsibility of your behavioral health provider to notify Tufts Health Plan when additional visits are needed.
How do I obtain additional sessions for medication management?
A psychiatrist or psychiatric clinical nurse specialist who provides medication management needs to notify Tufts Health Plan of an initial medication management evaluation. Additional medication management visits (15-20 minutes in length with no therapy) do not require notification to Tufts Health Plan and are unlimited throughout the year. You are responsible for your office visit co-pay for these visits.
When does my yearly benefit renew?
Most policies renew on January 1. However, policies vary. You can verify your annual effective dates either with your employer, by logging in to your secure member portal, checking your benefit document, or calling our Behavioral Health Department at 800-208-9565.
How do I know how many visits I have for the year?
The number of visits available to Tufts Health Plan members varies. Co-payments may also vary. You can review your copayment amounts by logging in to your secure member portal, checking your benefit document for details, or calling our Behavioral Health Department at 800-208-9565.
How do I obtain authorization for psychological or neuropsychological testing?
Prior authorization is required for psychological and neuropsychological testing. Providers are required to submit a request form prior to an initial testing evaluation. Your provider can obtain the appropriate prior authorization request form in our Provider Resource Center.
How do I access inpatient behavioral health treatment?
Members should go to the nearest emergency room (ER) for a level of care evaluation to determine the most appropriate treatment. The ER team will contact Tufts Health Plan to determine where services can be obtained based on your clinical needs and your coverage.
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