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 instructions on how to join the Tufts Health Plan network:

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

Important Information

For more information about the credentialing and recredentialing processes, refer to the applicable Tufts Health Plan Provider Manual below:

• 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@point32health.org.
• After the credentialing committee reviews the application, Tufts Health Plan will inform the provider of the credentialing decision in writing.
• Tufts Health Plan schedules re-credentialing cycles for contracted providers at least every two years to meet regulatory and accreditation guidelines.
• Provider Requirement: Federal regulations require that providers who render services to Medicaid members are screened by and enrolled with the appropriate state Medicaid agency. This requirement applies to providers who participate in Tufts Health RITogether or Tufts Health Together – MassHealth MCO Plan and Accountable Care Partnership Plans (ACPPs).
  • Tufts Health RITogether: Complete this screening and enrollment process via the Rhode Island Executive Office of Health and Human Services (EOHHS) provider portal.
  • Tufts Health Together: Complete this screening and enrollment process via the MassHealth website. For more information, refer to this FAQ.
• 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)