Tufts Health Plan Senior Care Options

Plan and product overview

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.

General benefit information

Coverage is provided for appropriately authorized, medically necessary services.

Authorization of 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.

Pharmacy

For pharmacy information pertaining to Tufts Health Plan Senior Care Options, refer to the Pharmacy section in the Provider Resource Center.

Behavioral health

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.