Credentialing and Contracting Overview

Join the Tufts Health Plan network

Credentialing and contracting are Tufts Health Plan's formal processes for adding providers to the Tufts Health Plan network and ensuring these providers give members quality care consistent with recognized managed care organization industry standards. Tufts Health Plan credentials and contracts with professionally competent providers and facilities who continually meet Tufts Health Plan's qualifications, standards and requirements.

Refer to the applicable provider page below for additional contracting and credentialing information:

• MDs, DOs, DPMs or Oral Surgeons
• Allied Health Providers
• Behavioral Health Providers

Note: In most cases, Tufts Health Plan approves clean and complete (no adverse responses) applications within 30 days of receipt. Applications with missing information or quality issues may take longer. To check the application status, email Tufts_Health_Plan_Credentialing_Department@tufts-health.com. Tufts Health Plan re-credentials providers at least every two years to meet regulatory and accreditation guidelines. For any questions about the credentialing process, email Tufts_Health_Plan_Credentialing_Department@tufts-health.com.

Correct erroneous information submitted by another party:
If Tufts Health Plan obtains or receives information during the credentialing process that varies substantially from the information provided in the application, Tufts Health Plan will notify the provider of the discrepancy. Providers have the right to review any information submitted in support of the credentialing application and to correct erroneous information other parties provide (excluding peer-review information). To submit corrections to the Credentialing Department, email provider_data_request@tufts-health.com. Note: Providers must submit corrections within 10 days of receipt.

After the credentialing committee reviews the application, Tufts Health Plan will inform the provider of the credentialing decision in writing.

Refer to the appropriate Tufts Health Plan Provider Manual for more information about the credentialing and recredentialing processes:

• Commercial
• Senior Products (Tufts Medicare Preferred HMO and Tufts Health Plan SCO)
• Tufts Health Public Plans (Tufts Health Direct, Tufts Health Together - Masshealth MCO Plan and Accountable Care Partnership Plans (ACPPs), Tufts Health RITogether and Tufts Health Unify)