Behavioral Health Authorizations
Tufts Medicare Preferred
The following information describes behavioral health authorization requirements for Tufts Medicare Preferred and Tufts Medicare Preferred Supplement:
Outpatient Services Requiring Prior Authorization for Commercial and Senior Products
Products
Tufts Medicare Preferred:
- 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
Authorization is not required.
- Inpatient Treatment
An inpatient notification is required.
- Claims Address
Tufts Health Plan Medicare Preferred
P.O. Box 178
Canton, MA 02021-0178
- 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.