Reminder: Review and Update Tufts Health Plan Provider Directory Information
All Tufts Health Plan Massachusetts, Rhode Island, Maine and Vermont providers have been enrolled in the directory section of CAQH ProView®. Note: On January 1, 2021, Tufts Health Plan began to phase out acceptance of provider directory edits directly from providers. On a quarterly basis, providers (or their designee) should log into CAQH ProView and review all their individual provider information to validate and provide updates in ProView as needed. Information that should be validated includes, but is not limited to:
- Availability to see new patients
- Phone number
- Practice locations (where members may make an appointment to see the individual provider at that location)
It is important that health plans and providers work together to ensure provider directories are more accurate and robust for members searching for care. Both Tufts Health Plan and CAQH have been actively seeking provider participation in connection with these efforts to keep our provider directories as up to date as possible. Therefore, Tufts Health Plan now requires that providers attest to the accuracy of their provider directory information every 90 days. Note: In order to ensure the directories are as accurate as possible, Tufts Health Plan may suppress any provider who has not re-attested to their information within the required timeframe. A provider’s directory information will be reinstated upon that provider’s confirmation of the accuracy of their information or by the submission of updated information.
Once enrolled, provider directory information (demographic data) will be transferred directly to Tufts Health Plan by CAQH, so providers will no longer need to notify Tufts Health Plan of these changes directly. Note: This change applies to directory information only.
Note: This does not apply to providers working exclusively within the Association for Behavioral Healthcare (ABH) or any individual provider who is not listed in the directory.
Other updates, such as adding or removing an affiliation or completely terminating from Tufts Health Plan, are considered contractual and must still be sent directly to Tufts Health Plan with the appropriate documentation.
Providers can update billing addresses by completing the appropriate Provider Information Change form and selecting “billing” as the address type. For more information on which form to use, refer to the Reminder: Update Your Billing and Contract Information article.
For more information about the provider directory, including a brief demonstration video by CAQH of how the system works, visit the CAQH website.