Provider Self Service
Technical requirements and support for the secure Provider portal
- Internet browser - Chrome, Firefox, Safari, and IE (8, 9, 10, 11-win 8.0, 11-win 8.1)
- Browser encryption (128-bit)
- Adobe Reader (Version 3.0 or higher is recommended)
For technical assistance:
To protect the privacy of Tufts Health Plan providers and members, the secure Provider portal requires a browser that supports 128-bit encryption. A strong encryption by industry standards, 128-bit encryption is compliant with the Health Insurance Portability and Accountability Act (HIPAA) that provides national standards to preserve the privacy and security of protected health information. A provider can only view claims that are related to his or her individual provider ID, and a provider unit can only view reports that are related to that individual provider unit. To further protect the privacy and security of information, Tufts Health Plan offers additional safeguards:
- If your computer session is inactive for 15 minutes, you will be required to log in again.
- If you exit the system in any way other than logging out via the secure Provider portal, you must wait 15 minutes before logging in again.
Registering a contracting provider ID allows you to access information containing that provider ID number, such as claims and referrals.
Go to the secure Provider portal log-in page and click "Register here". Determine the type of registration you need to complete. To add an additional provider or providers to your existing account, click “I need additional access” or to register a new account, click “Continue with registration”.
You will need the following information to add additional providers or create a new account:
- NPI (National Provider Identification)
- One of the following:
- Tax ID number (group registrations)
- Social Security Number (individual registrations)
- Information from two recent claims submitted by the provider
Select your role:
If you are registering to be the SAA of the NPI entered and there is already an NPI in place, you must select “Replace current SAA” or “Cancel to start over” and select a different role.
Are you registering as the provider or on behalf of the provider?
If you are registering as the provider:
Select “Provider”, and then enter the last four digits of your SSN or your TIN
If you are registering on behalf of the provider:
Select “On behalf of provider”, and then provide one of the following to continue:
- Last four digits of the provider’s SSN
- The provider’s TIN
- Information from two recent claims submitted to THP by the provider
*Refer to Roles and Responsibilities for secure Provider portal users below for more information on Access Administrators
Complete the account information page:
- If you are the provider, you will need to answer security questions to validate your identity. Once you complete the questions correctly, you will be able to access the secure Provider portal.
- If you are registering on behalf of the provider, you will be required to list the provider’s email address. An email will be sent to the provider requesting he/she approve or reject your request. The provider will also be asked to answer security information to validate his or her identity. If the request is approved, you will receive an email indicating you may not access the secure Provider portal.
If I have several providers in my office, can I register for access to multiple providers at once?
Yes. If there are several providers in your organization, you can select “To register at the provider organization level”.
Do I need a separate log-in for each provider or provider unit?
No, you can access multiple providers with a single log-in.
What functionality is available on the secure Provider portal?
Secure Provider portal functionality includes:
- Claim Adjustments and Claim Disputes
- Eligibility and Benefits Inquiry
- Referral Inquiry
- Referral Submission for Medical Services
- Prior Authorization Inquiry
- Inpatient Notification Submission
- Provider/Provider Unit Reports
- Behavioral Health Services Request
- Access Administration
- InterQual® SmartSheets™
For more information on secure Provider portal functionality, call Provider Services and select the option for Web Support.
Searching for a member
To search for a member, use one of these four options:
- Identify a member by first name, last name and date of birth
- Identify a member by full member ID number, including two-digit suffix
- Using the Advanced Search option, search for a subscriber member ID number without the two-digit suffix. Select applicable member from the list.
- Use our free form search, available in the Referral and Claims tool, to search by multiple fields such as Provider ID, Patient Name, DOS, etc.
Viewing member eligibility and benefits:
- Log on to the secure Provider portal
- From top navigation, click Eligibility & Benefits
- Search for a member using Provider Name and ID and Patient Name. DOS is optional.
- To view a member's Effective Date, PCP History, and other details, click the Eligibility tab.
For more information, refer to the Eligibility and Benefits Inquiry guide.
Can I change my password online?
To change your password, click on Personal Password on the Account Services page to enter a new password. If you forget your password, you will be prompted with the hint question you selected upon setting up your account. When you respond to the hint question with your secret word, your password will be displayed.
Roles and responsibilities for secure Provider portal users
- Senior Access Administrator (SAA): Creates and modifies accounts for access administrators and authorized users.
- Access Administrator: Authorized by the senior access administrator to grant authorized user access to your Tufts Health Plan website account, create and modify accounts for authorized users.
- Authorized User: Created by a SAA and/or access administrator to use the secure Provider portal. The secure Provider portal offers the Access Administration feature on the Welcome to Provider Self Service page or in the left navigation pane under Self Service. This feature allows the Access Administrator to create new users and modify existing user functionality.