Member Eligibility

Tufts Health Public Plans

Always be sure to verify a patient’s eligibility on the date of service to ensure claims payment. You can verify that a patient is a Tufts Health Public Plans member on the date of service via the web or phone. You can also help your patients keep their benefits.

Please note: If you are a primary care provider (PCP), make sure the Tufts Health Public Plans patient is assigned to your panel. We do not pay claims for services you render to a Tufts Health Public Plans patient who is not assigned to your panel unless you obtain prior authorization.

Aging Services Access Points for One Care members

If you are a provider and are proposing to treat a Tufts Health One Care member for which you are not contracted, please check with the local Aging Services Access Point (ASAP). They will have information on whether a service is covered, if prior authorization is needed, and how to bill for such service.

Services that ASAPs coordinate for Tufts Health One Care Members:

  • Home Delivered Meals
  • Grocery & Shopping
  • Homemaking
  • Laundry
  • Companion
  • Light Chore/Heavy Chore
  • Home Health Aide (HHA) * If not part of VNA services
  • Supportive Home Care Aide (SHCA)
  • IL Peer Support
  • IL Skills Training