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.