If you are a Tufts Health Together (MassHealth), Tufts Health RITogether (Rhode Island Medicaid), Tufts Health Unify (Medicare-Medicaid plan), or Tufts Health Plan Senior Care Options (65+ Medicare-Medicaid plan) member: You may need to renew your coverage this year. Learn more.
A notice to our members regarding a security incident. Read here.
Note: This information is intended to provide an overview. Providers are reminded to check the member’s ID card to verify the plan in which the member is enrolled. Services and subsequent payment are pursuant to the member's benefit plan document. Prior to initiating services, member eligibility and benefits should be verified by logging on to the secure Provider website.
For information on Complaints, Grievances and Appeals processes see the Complaints, Grievances and Appeals page.
Coverage is provided for appropriately authorized, medically necessary services.
Tufts Health Plan’s Precertification Operations Department may require a referral, inpatient notification, or prior authorization for certain services. For a complete description of authorization and notification requirements, refer to the Prior Authorizations and Notifications chapters of the Tufts Health Plan Senior Care Options Provider Manual, as well as the Authorization and Notification Policy.
For pharmacy information pertaining to Tufts Health Plan Senior Care Options, refer to the Pharmacy section in the Provider Resource Center.
Tufts Health Plan covers medically necessary outpatient, inpatient and intermediate services for behavioral health and substance use disorders (BH/SUDs), as defined by the member’s benefit plan document. For more information, refer to the Outpatient BH/SUD Professional Payment Policy, the Inpatient and Intermediate BH/SUD Facility Payment Policy and the Behavioral Health section.
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