- Behavioral Health
- Commercial Plans
- Tufts Health Public Plans
Commercial Plans Behavioral Health
Providers should confirm member benefits prior to rendering services. Members are covered as described in their benefit document. Providers can obtain specific benefit information by:
- Logging in to the secure Provider website
- Using the interactive voice response (IVR) system by calling 800.208.9565
- Speaking to a Behavioral Health Coordinator at 800.208.9565. The Behavioral Health Department is open Monday, Tuesday, Wednesday and Friday 8:30 a.m.–5 p.m. and Thursday 9 a.m.–5 p.m.
Facility Assignment by Plan Type
• HMO members must seek treatment at their assigned DF.
• If a member is not assigned to a DF, the PCP arranges the member’s care
• EPO members can seek treatment at any Tufts Health Plan DF.
• POS members have two levels of benefits:
• Authorized: services rendered at any Tufts Health Plan DF
• Unauthorized: services rendered at any facility outside of the Tufts Health Plan DF system (contracting and noncontracting)
• PPO members also have two levels of benefits:
• In-network: services rendered at any Tufts Health Plan contracted facility
• Out-of-network: services rendered at any noncontracted facility
• CareLinkSM members’ coverage varies by plan design and depends on which party is the primary administrator. Verify the member’s benefit prior to rendering services.
For more information, refer to the Inpatient Behavioral Health/Substance Use Disorder Payment Policy.
*Some employer groups may have chosen a third party to manage and administer BH/SUD benefits. If the member is unsure, please have them check their Tufts Health Plan identification card or contact the Behavioral Health Department at 800.208.9565.