Program Information

Commercial

Behavioral Health Services for Children and Adolescents

Coverage is provided for benefits related to children and adolescents up to age 19 with behavioral health disorders that substantially interfere with or substantially limit their functioning and social interactions.

Medical Necessity Guidelines

Payment Policies

Authorization Requirements

Outpatient Treatment Notifications

Who submits the notifications?

It is the treating provider’s responsibility to submit the notification for outpatient behavioral health and substance use disorder services. Notifications must be obtained for members covered under Mental Health Parity laws. Outpatient behavioral health services must be medically necessary. View the Outpatient Psychotherapy Medical Necessity Guidelines.

Initial notifications

Providers must provide an initial notification for patients who are new to the practice. If the patient is not new but the previous notification is more than 12 months old and has therefore expired, providers must submit a new notification. Upon submission of the initial notification, 8 visits will be available.

Notifications for Additional Visits

Providers must submit a notification for patients who are continuing with their treatment and have exhausted all visits within the 12 month date range. The member may also submit a subsequent request. This notification will grant an additional 8 visits.

Outpatient Notification Processing

In April 2020, Tufts Health Plan began using a new clinical management system that caused changes to the processing of outpatient notifications. Providers contracting with all Commercial products (including Tufts Health Freedom Plan) are still required to submit notifications for outpatient behavioral health services. Note: This excludes Commercial PPO products.

Providers will continue to be required to use the IVR or the secure Provider website to submit the notification, and should note the following:

IVR

Providers submitting the notification via the IVR will no longer receive the notification number (i.e., the confirmation number indicating that their request for visits was successful) immediately after entering the information. Instead, providers will hear a message that the request was successfully submitted, indicating that Tufts Health Plan has received their notification and is processing the information.

Secure Provider Website

Providers submitting the notification via the secure Provider website will be able to view their outpatient notification request information on the secure Provider website 24 hours after the notification has been submitted. For more information, including instructions on how to review notifications using the secure Provider website, refer to the Behavioral Health Authorization and Portal User Guide.

Note: If you are not yet a registered user of the secure Provider website, registration information is available on the Tufts Health Plan and Tufts Health Freedom Plan public Provider websites. Contracting providers may grant access to the secure Provider website to their administrative staff. For more information, providers should call the appropriate call center.

Notification Letter

Providers submitting notifications for either the IVR or secure Provider website will receive a letter via mail that confirms receipt and includes the notification number. Note: Before, the notification number began with a V, K or R. The notification number will now begin with 00. Keep the notification number on file to verify you notified Tufts Health Plan of these visits.

The letter also includes the approved procedure code 90899. This is a generic therapy procedure code and is not related to the type of services you have requested. Providers may begin billing for visits as soon as they’ve submitted the notification information. Claims will process as long as the required notification is on file.

Tools and Resources

Please e-mail us your availability at mh_providers@tufts-health.com.

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