Products: Commercial
Effective for dates of service on or after June 1, 2017.
Forensic Review is a prepayment itemized bill review service that applies condition-specific medical and financial expertise to review high-dollar inpatient claims for the following:
- Unbundling
- Experimental/plan language benefit
- Billing errors
- Incorrect charges
- Insufficient descriptions
- Incorrect bill types
- “Never events”
- Level of care discrepancies
Providers may receive emails from forensicreviewrequest@tufts-health.com regarding inquiries including but not limited to itemization requests, determination summaries, and requests for more information (RFMI).
For general questions about the Forensic Review program, contact Provider Services at 888.884.2404
For questions regarding claims or review decisions, contact:
Claims Resolution
Equian, LLC
600 12th Street, Suite 300
Golden, CO 80401
Email: claimsresolution@equian.com
Phone: 888.895.2254 (direct)
For questions regarding first level appeals, contact:
Equian, LLC
Attn: Claim Disputes
600 12th Street, Suite 300
Golden, CO 80401
Email: reconsiderations@equian.com
Fax: 866.700.5769
All second level appeals can be submitted through Tufts Health Plan’s secure Provider portal or mailed to:
Provider Payment Disputes
P.O. Box 9190
Watertown, MA 02471-9190