Claims, Referrals and Prior Authorizations

Tufts Health Public Plans

Claims information

For claims related information, refer to the following:

• Tufts Health Public Plans Provider Manual
• Avoiding Administrative Claim Denials
• Provider Payment Dispute Policy

Referrals

For referral information, refer to the following:

• Tufts Health Public Plans Provider Manual
• Referral, Prior Authorization and Notification Policy

Prior Authorization

For prior authorization (PA) information for medical services, refer to the following:

• Tufts Health Public Plans Provider Manual
• Referral, Prior Authorization and Notification Policy

For PA information for behavioral health services, refer to the following:

• Tufts Health Public Plans Provider Manual
• Tufts Health Together and Tufts Health Direct Behavioral Health PA and Notification Grid
• Tufts Health RITogether Behavioral Health PA and Notification Grid
• Tufts Health Unify Behavioral Health PA and Notification Grid

For pharmacy PA information, refer to the Tufts Health Public Plans Pharmacy Overview.