Commercial and Senior Products Provider Portal
For providers contracted with Commercial, Tufts Medicare Preferred HMO or Tufts Health Plan SCO
Reasons to register
Powerful Transaction Capabilities
Our Web-based self-service application suite offers several transactions, including:
- Claims status inquiry: Enter basic member or claim-specific data and obtain detailed claim status information
- Eligibility and benefit inquiry: Enter basic member identification data and obtain a concise, online eligibility report and member-specific benefits
- Referral submission: Submit referrals online directly to Tufts Health Plan and instantaneously receive a referral authorization
- Referral inquiry: Check the status of submitted referrals and high-tech imaging authorizations
- Inpatient notification requests: Obtain a real-time inpatient notification number instead of using the phone or fax
- Online claim adjustments: Correct claims, submit payment disputes, and return funds
- InterQual® SmartSheets™: Access criteria to support care planning and level-of-care decisions and SmartSheets to request prior authorization for some services
- Clinical Quality Management reporting to track patient disease management
Open the Commercial/Medicare/SCO Registration Page
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”
- You will need to 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”
- You will need to 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
- 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 now access the secure provider portal.
Call Provider Services at 888.884.2404
weekdays 8:30am - 5:00pm.
Or email us for technical assistance.