Behavioral Health Authorizations

Tufts Medicare Preferred HMO

The following information describes behavioral health authorization requirements for Tufts Medicare Preferred HMO and Tufts Medicare Preferred Supplement:

Outpatient Services Requiring Prior Authorization for Commercial and Senior Products

Products

Tufts Medicare Preferred HMO:

  • Outpatient Psychological/Neuropsychological Testing
    Approval is required. Contact the member’s PCP for authorization.
  • Outpatient Treatment
    Prior referral authorization is required from the member’s PCP.
    Services rendered in SNF and LTC settings are excluded.
  • Intensive Outpatient/Partial Hospital Treatment
    The member is generally assigned to a Designated Facility (DF).
  • Inpatient Treatment
    The member is generally assigned to a Designated Facility (DF). An inpatient notification is required.
  • Claims Address
    Tufts Health Plan Medicare Preferred
    P.O. Box 9163
    Watertown, MA 02471
  • Filing Deadline
    Send within 60 days of the date of service or date of discharge.

Tufts Medicare Preferred Supplement:

  • Outpatient Psychological/Neuropsychological Testing
    Coverage for services rendered by Medicare-participating providers only. Authorization is not required.
  • Outpatient Treatment
    Coverage for services rendered by Medicare-participating providers only. Authorization is not required.
  • Intensive Outpatient/Partial Hospital Treatment
    Facility must be Medicare participating.
  • Inpatient Treatment
    Hospital must be Medicare participating. Inpatient notification is not required.
  • Claims Address
    Claims should be sent directly to Medicare.
  • Notes
    Medicare is the primary insurance.

For questions regarding authorization and/or inpatient notification, contact the Behavioral Health Department at 800.208.9565.

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