Coronavirus (COVID-19) Updates for Providers

The following applies to all Tufts Health Plan products:

• Tufts Health Plan will pay 100% of the allowed amount for medically necessary lab testing. Click here for a list of procedure codes.
• There will be no member cost sharing (i.e., no copays, deductible, or coinsurance). Providers should not collect a copay from members.
• Testing, including antibody testing and rapid testing, is covered when determined by a PCP or other provider who has performed an individualized clinical assessment to be medically necessary in accordance with current CDC and state public health department guidelines, which are being continuously updated. Note: COVID-19 testing may be ordered by any state-authorized health care professional for Tufts Medicare Preferred HMO, Senior Care Options (SCO) and Tufts Health Unify. Tufts Health Plan will continue to update this guideline as new guidance is issued.
• Member reimbursement requests for home testing kits, or other tests that are self-ordered by members, are not covered.
• Testing is not covered if conducted soley for return-to-work or return-to-school purposes, for travel purposes unrelated to seeking medical care, for public health surveillance, or for any other purpose not primarily intended for individualized diagnosis or treatment.
  • When performing any such tests, including non-diagnostic or occupational tests for return-to-work scenarios, providers should bill the appropriate laboratory code following our existing billing guidelines (e.g U0002) and use the diagnosis code.
• FDA-authorized antibody testing for COVID-19 is covered only when it has been determined by a provider who has performed an individualized clinical assessment to be medically necessary to make decisions about a member's care.
• Testing for asymptomatic members is covered when being admitted to a health care facility or when the member has been identified by a health care provider, the state or local board of health as someone who is a close contact of someone who has COVID-19. For all other asymptomatic persons, testing is not covered.
• Members are encouraged to see in-network providers, whenever possible. However, this policy applies to in-network and out-of-network (OON) providers.

The following applies to all Tufts Health Plan products:

• Tufts Health Plan will pay 100% of the allowed amount for other medically necessary diagnostic testing (including, but not limited to radiology and other lab tests).
• There will be no member cost sharing (i.e. no copays, deductible, or coinsurance). Providers should not collect a copay from members.
• Members are encouraged to see in-network providers, whenever possible. However, this policy applies to in-network and out-of-network (OON) providers.

The following applies to all Tufts Health Plan products:

• Tufts Health Plan will reimburse providers for treatment according to covered benefits in our plans for those members positively diagnosed with COVID-19. Note: Per CMS, Senior Products and Tufts Health Unify providers on an IPPS-DRG payment will receive add-on payments for the treatment of COVID-19.
• There will be no member cost sharing (i.e. no copays, deductible or coinsurance). Providers should not collect a copay from members. This applies to all in-person treatment regardless of place of service, including inpatient and skilled nursing facility (SNF) services. Note: This applies to all services (i.e., medications, DME, etc.) provided at the appointment by the provider.
• Tufts Health Plan will affirm a positive diagnosis with the presence of the following diagnosis codes:
  • ICD-10 code U07.1 is used as a primary diagnosis.
    • Effective for discharge/dates of service on or after September 1, 2020 this code should be used as a positive diagnosis for COVID-19.
    • U07.1 was developed by the World Health Organization (WHO) and is intended to be sequenced first followed by the appropriate codes for associated manifestations when COVID-19 meets the definition of principal or first-listed diagnosis. However, if COVID-19 does not meet the definition of principal or first-listed diagnosis (e.g. when it develops after admission), then code U07.1 should be used as a secondary diagnosis. For further guidance, please refer to the official ICD-10-CM guidelines for coding encounters related to the COVID-19 coronavirus outbreak.
  • ICD-10 code B97.29 is used as either a primary diagnosis or a secondary diagnosis appended to a respiratory illness.
    • Prior to April 1, 2020, B97.29 was accepted as a positive diagnosis for COVID-19.
    • For discharge/dates of service on or after September 1, 2020 this code will not be accepted as a positive diagnosis for COVID-19.
• Effective for dates of service on or after November 9, 2020, monoclonal antibody treatment (bamlamivimab) is covered (without utilization management) for the treatment of mild to moderate COVID-19 in adult and pediatric patients with positive COVID-19 test results who are at high risk for progressing to severe COVID-19 and/or hospitalization. Treatment is administered in the hospital outpatient setting. Senior Products member claims should be submitted to Medicare Administrative Contractors (MACs). Tufts Health Commercial and Tufts Health Public Plans products follow the standard claims submission processes.
• Members are encouraged to see in-network providers, whenever possible. However, this policy applies to in-network and out-of-network (OON) providers.

The following applies to all Tufts Health Plan products:

• Tufts Health Plan will reimburse providers for treatment according to covered benefits in our plans for those for whom COVID-19 is suspected but without a positive diagnosis of COVID-19.
• There will be no member cost sharing (i.e., no copays, deductible or coinsurance).  Providers should not collect a copay from members. This applies to all in-person treatment regardless of place of service, including inpatient and SNF services. Note: This applies to all services (i.e., medications, DME, etc.) that are provided at the appointment by the provider.
  • Tufts Health Plan will affirm a non-positive diagnosis with the absence of ICD-10 code U07.1 as a primary diagnosis.
  • Tufts Health Plan will affirm a non-positive diagnosis with the absence of ICD-10 code B97.29, used as either a primary diagnosis or a secondary diagnosis appended to a respiratory illness.
    • For discharge/dates of service on or after September 1, 2020, this code will not be accepted as a positive diagnosis for COVID-19.
  • Tufts Health Plan may further affirm a non-positive diagnosis with the presence of ICD-10 code Z03.818, which denotes a ruled-out COVID-19 diagnosis.
  • Tufts Health Plan may further affirm a non-positive diagnosis with the presence of ICD-10 code Z20.828, which denotes exposure but no confirmed COVID-19 diagnosis.
• Members are encouraged to see in-network providers, whenever possible. However, this policy applies to in-network and out-of-network (OON) providers.

Once a COVID-19 vaccine becomes available to members, Tufts Health Plan will cover the vaccine in full. There will be no cost to members. Refer to the COVID-19 Vaccination Payment Policy and the Coronavirus (COVID-19) Vaccination Frequently Asked Questions (FAQs) for Providers for additional information.


Tufts Health Plan complies with federal and state guidelines for vaccines. Refer to the DPH for Massachusetts, Rhode Island, and New Hampshire for information on vacccines.

The following telehealth/telemedicine policy has been implemented for all Tufts Health Plan products to prevent members from needing to leave their home to receive care. This policy applies for all diagnoses and is not specific to a COVID-19 diagnosis.
 

• Tufts Health Plan will compensate in-network providers at 100% of their contracted rate for services rendered in person, as specified in provider agreements, until further notice. The telehealth reduction will not apply. Note: Tufts Health Plan is not paying a separate rate for hosting telehealth service for Commercial products.
• All Tufts Health Plan contracting providers, including specialists and urgent care facilities, may provide telemedicine services to members for all medical (well visits/preventive, sick visits, preadmission screenings), behavioral health, ancillary health and home health care visits (i.e. skilled nursing, PT, OT and ST) for both new and existing patients. Prior authorization is not required.
• Tufts Health Plan will waive member cost share for in-network telehealth services.  This includes both facility and professional services. Providers should not collect a copay from members. Note: Effective for dates of service on or after January 1, 2021, member copays and other applicable cost share will be applied to all non-COVID-19 telehealth services, with the exception of primary care and behavioral health telemedicine services for Rhode Island Commercial members. Member copays and other applicable cost share will continue to be waived for COVID-19-related, in-network, medically necessary services. A COVID-19 diagnosis must be submitted on the claim for the waived cost share to continue to apply.
• Telehealth also includes telephone consultation. Note: For Medicare products, under CMS rules, special codes already exist for certain telephonic services and those codes will be paid at the CMS fee schedule.
• Documentation requirements for a telehealth service are the same as those required for any face-to-face encounter, with the addition of the following:
  • A statement that the service was provided using telemedicine or telephone consult;
  • The location of the patient;
  • The location of the provider; and
  • The names of all persons participating in the telemedicine service or telephone consultation service and their role in the encounter.
• Services covered under telehealth should be clinically appropriate and not require in-person assessment and/or treatment.  Tufts Health Plan defers to the provider to make this determination.
• Note for Behavioral Health Providers: There are no restrictions on service type, including individual and group behavioral health services. Additionally, the usage of audio without video is acceptable.

Note: Providers do not need to use Teladoc to provide services to our members. As previously communicated, Teladoc is an additional benefit available to Commercial members that is not impacted by the above change.
 

For dates of service after July 20, 2020, pre-COVID coverage policies and benefits (including applicable cost share) will apply for out-of-network (OON) telemedicine. Prior to July 20, 2020 the following telehealth policies were in place for OON providers:

• Referrals and/or authorizations for plans which require referrals and/or authorizations to see OON specialists were waived for telehealth services, when services were related to the following:
  • COVID-19
  • Inpatient care
  • Post-acute care, including inpatient rehab, skilled nursing facilities, long-term acute care (LTAC), and/or home care following an inpatient admission
  • Primary care or outpatient behavioral health services
• No member cost share for facility and professional services.

Providers must submit telehealth claims in accordance with applicable state and federal requirements. Tufts Health Plan will compensate in-network providers at 100% of their contracted rate for services rendered in person, as specified in provider agreements. The telehealth reduction will not apply. Note: Tufts Health Plan is not paying a separate rate for hosting a telehealth service for Commercial Products.

Services covered under telehealth should be clinically appropriate and not require in-person assessment and/or treatment.  Tufts Health Plan defers to the provider to make this determination.

Note: Effective for dates of service on or after January 1, 2021, member copays and other applicable cost share will be applied to all non-COVID-19 telehealth services, with the exception of primary care and behavioral health telemedicine services for Rhode Island Commercial members. Member copays and other applicable cost share will continue to be waived for COVID-19-related, in-network, medically necessary services. A COVID-19 diagnosis must be submitted on the claim for the waived cost share to continue to apply.

Professional Claims

Providers should submit claims for telehealth visits, as outlined below.
 

Commercial and Tufts Health Direct

Submit claims with place of service (POS) 02 OR the appropriate telehealth modifiers (see table below) to differentiate a telehealth visit from an in-person visit. Note: Tufts Health Plan will accept the POS that would have been used, had the services been rendered in person, provided the appropriate telehealth modifier is also on the claim to indicate a telehealth visit.
 

Tufts Medicare Preferred

In accordance with CMS guidelines, submit claims with modifier 95 to indicate a telehealth visit. Note: Providers should not submit claims with GO or GQ modifiers.

Tufts Health Plan SCO and Tufts Health Unify

In accordance with CMS and MassHealth guidelines, submit claims with modifiers GT and 95 and POS 02.
 

Tufts Health Together

In accordance with MassHealth requirements, submit claims with modifier GT and POS 02.

 

Tufts Health RITogether

In accordance with Rhode Island EOHHS requirements, submit claims with POS 02. Effective February 1, 2021, telehealth claims submitted with a POS other than POS 02 will deny.
 

Facility Claims

For facility claims, providers should submit the appropriate Revenue Code, CPT/HCPCS code(s) and modifier(s).

In addition to the guidelines above, providers should continue to bill with the appropriate license-level modifier and all other billing guidelines as specified in the applicable payment policy.
 

Modifiers	Modifier Description	Modifier Definition
95	Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System	Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. The totality of the communication of information exchanged between the physician or other qualified health care professional and patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. Modifier 95 may only be appended to the services listed in Appendix P. Appendix P is the list of CPT codes for services that are typically performed face-to-face but may be rendered via real-time (synchronous) interactive audio and video telecommunications system.
GT	Via interactive audio and video telecommunication systems	Modifier used to indicate telehealth services. Except for demonstrations in Alaska and Hawaii, all telehealth must be interactive.
GQ	Via asynchronous telecommunications system	Modifier used to indicate telehealth services. Except for demonstrations in Alaska and Hawaii, all telehealth must be interactive.
G0	Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke	None provided

Refer to the Temporary COVID-19 Telehealth/Telemedicine Code List for Commercial, Senior Products and Tufts Health Public Plans for a list of common telehealth codes accepted by Tufts Health Plan. These lists are not all inclusive nor a guaratee of payment or final indiction of how specific claim(s) will be adjudicated.

Tufts Health Plan is waiving referral requirements, until further notice, for all in-network care, regardless of diagnosis, for all Tufts Health Plan products, with the exception of Tufts Health Freedom Plan.

This temporary referral policy applies to all fully-insured and self-insured groups*, however, self-insured groups do have the option to opt-out and those opt outs may not be specifically listed. To confirm referral opt outs for self-insured groups, contact Provider Services.

If a member's plan requires a referral or authorization to received out-of-network (OON) services, Tufts Health Plan is waiving such requirements for the OON services listed below when related to a COVID-19 diagnosis regardless of member's plan type:

• Inpatient care
• Post-acute care, including inpatient rehab, skilled nursing facilities, long-term acute care (LTAC), and/or home care following an inpatient admission
• Primary care or outpatient behavioral health services
• Urgent/emergent services

For dates of service after July 20, 2020, Tufts Health Plan’s pre-COVID coverage policies and benefits (including applicable cost share) will apply for out-of-network (OON) services. All plans that require a referral or authorization to receive OON services will again need to follow standard, pre-COVID procedures for receiving OON care. The only exception is for COVID-related care, for which authorization requirements continue to be waived.

Prior to July 21, 2020 the following policies were in place for OON providers:

• If a member’s plan requires a referral or authorization to receive out-of-network (OON) services, Tufts Health Plan waived such requirements for OON services related to the following, regardless of a COVID-19 diagnosis or of member’s plan type:
  • COVID-19
  • Inpatient care
  • Post-acute care, including inpatient rehab, skilled nursing facilities, long-term acute care (LTAC), and/or home care following an inpatient admission
  • Primary care or outpatient behavioral health services
• Plans which required referrals and/or authorizations to see OON specialists continued to require referrals and/or authorizations unless services were related to the above. Note: The referral and/or authorization requirement refers to in-person and telehealth services.
• The in-network cost share was applied at the authorized level of benefits for all OON services listed above unless it was for a service that Tufts Health Plan was waiving cost share.
• Tufts Health Plan reserves the right to transfer inpatient care from an OON provider to an in-network provider when the transfer can be facilitated appropriately.
• Claims for the services above will not be denied for being OON for dates of service on or before July 20, 2020. Note: There is an industry-standard possibility that claims may deny for other unrelated and appropriate reasons.

Note: Tufts Health Plan follows regulatory guidance and/or standard processes for determining payment to OON providers.

The following applies to all Tufts Health Plan products:

• Diagnoses and treatments related to COVID-19 or known or suspected of having COVID-19 contraction: (presence of ICD-10 codes ICD-10 code U07.1, B97.29*, Z03.818, and/or Z20.828):
  • Prior authorization is not required.
  • Notification is required within 5 days after the date of admission.

*Note: For discharge/dates of service on or after September 1, 2020 B97.29 will not be accepted as a positive diagnosis for COVID-19, U07.1 should be used.

The following prior authorization guidelines are in effect until further notice and apply to all diagnoses and not specific to a COVID-19 diagnosis:

• As a reminder, urgent/emergent admissions are never subject to prior authorization.
• Prior authorization is not required for non-hospital locations for post-acute care (i.e. inpatient rehab, LTAC, skilled nursing facilities and home care), including following an inpatient hospital admission. All other post-acute policies remain unchanged.
• Prior authorization is not required for hospice services.

With respect to prior authorization requirements for inpatient treatment or outpatient scheduled surgeries and admissions to acute care hospitals or mental health hospitals:

• Prior authorization for Massachusetts Commercial Products and Tufts Health Direct are suspended for any inpatient treatment or outpatient scheduled surgeries or admissions to acute care hospitals or mental health hospitals through March 31, 2021 due to the issuance of Massachusetts Division of Insurance Bulletin 2020-21, which was extended through March 31, 2021 by Insurance Bulletin 2020-31.
• For all other states and product lines, standard PA requirements and processes should be followed for services occuring on or after July 1, 2020.

The following prior authorization guidelines remain in place throughout the COVID-19 emergency:

• Sleep study prior authorization and notification requirements through eviCore healthcare (eviCore), Tufts Health Plan’s sleep benefit manager, remain in place. For more information, refer to Sleep Management Program.
• High-tech imaging prior authorization requirements through National Imaging Associates (NIA) remain in place. For more information, refer to High-Tech Imaging Prior Authorization Program.

Prior authorization and notification is not required for the following behavioral health services:

• Applied Behavioral Analysis (ABA) for all products
• Children’s Behavioral Health Initiative (CBHI) for Tufts Health Together,
• Behavioral Health for Children and Adolescents (BHCA) for Massachusetts Commercial products
• Home-Based Therapeutic Services (HBTS) for Tufts Health RITogether
• Psychology/Neuropsychology testing and rTMS for Rhode Island Commercial products 

Note: Providers are still responsible for confirming the service is covered by the individual treatment plan and the member meets medically necessary criteria for the service.

The following inpatient notification guidelines apply to all diagnoses and are not specific to a COVID-19 diagnosis:

• Tufts Health Plan is relaxing admission notification requirements for urgent/emergent inpatient admissions and post-acute admissions by requiring notification within 5 days after the date of admission.
• Tufts Health Plan continues to require inpatient notification pursuant to standard timelines for elective non-COVID-19 admissions.
• Hospice services do not require inpatient notification.

Note: Tufts Health Plan remains available to assist with discharge planning for all admissions and reserves the right to retroactively review services for medical necessity.
 

The following concurrent review guidelines apply to all diagnoses and are not specific to a COVID-19 diagnosis until December 31, 2020 (extended through March 31, 2021 for Massachusetts Commercial Products and Tufts Health Direct):

• Concurrent review is suspended for all urgent/emergent hospital inpatient services.
• Concurrent review is suspended for any inpatient or outpatient scheduled surgeries, for behavioral health or non-behavioral health admissions at acute care and mental health hospitals.

Note: Post-acute care treatment at non-hospital locations are subject to concurrent review for COVID-19 and non-COVID-19 related illnesses.

Note: Tufts Health Plan remains available to assist with discharge planning for all admissions and reserves the right to retroactively review services for medical necessity.
 

Tufts Health Plan is informed when CMS and state insurance agencies issue new billing and reimbursement guidelines in response to the COVID-19 emergency. These guidelines are reviewed by Tufts Health Plan and implemented, as appropriate. Providers should not  await billing instructions from Tufts Health Plan.

Providers should follow guidelines on this page for dates of services listed during the public health emergency (PHE) and continue to submit claims as they currently do. For all other billing guidelines, refer to the Professional Services and Facilities Payment Policy and the benefit-specific payment policies located in the Provider Resource Center.

Unless otherwise stated, Tufts Health Plan follows industry standard coding guidelines. Refer to current coding guidelines for a complete list of ICD, CPT/HCPCS, revenue codes, modifiers and their usage.

Note: Providers may bill inpatient for services provided at alternative inpatient sites.

The following applies to all Tufts Health Plan products:

• Certified registered nurse anesthetists (CRNA) are not required to include the supervising physician information on claims. Note: Tufts Health Plan will continue to compensate for medically necessary CRNA services.
• Anesthesia claims should be billed with the appropriate procedure code, modifier and applicable time units, as described in the Anesthesia Payment Policies for Commercial and Senior Products and Tufts Health Public Plans.
• Tufts Health Plan defers to providers to determine whether physician supervision is required under the laws of the state in which they practice and/or hospital policies.

The following applies to all Tufts Health Plan products, effective as outlined below:

• The timeframe for filing provider appeals was extended by up to 90 days from Tufts Health Plan's standard appeals timeline, upon request, effective through December 31, 2020.
• Tufts Health Plan is providing extended timeframes for provider audits of hospital claims only through December 31, 2020 (extended through March 31, 2021 for Massachusetts Commercial Products and Tufts Health Direct).

The following changes will be effective April 8, 2020 through the dates indicated below:
 

Pre-Payment Billing Review Programs - Effective as outlined below

Orthonet:

• The Orthonet Program resumed as of October 1 , 2020.
• Claims denied prior to April 8, 2020 for failure to produce documentation will remain denied until documentation is provided. Orthonet will complete reviews and issue findings.

Forensic Review:

• The Forensic Review Program will resume effect January 1, 2021.
• No new record requests will be issued from April 8, 2020 to December 31, 2020.
• Claims denied prior to April 8. 2020 for failure to produce documentation will remain denied until documentation is provided. The vendor will complete reviews and issue findings per existing processes.
• Effective through December 31, 2020, providers will have 90 days from the date of the determination to appeal to the vendor.

Post-Payment Billing Review Programs - Effective through December 31, 2020

Record requests

• New requests:
  • Vendors will continue to request records per existing processes.
  • Providers will have 90 days from the date of the initial request to submit records.
• Outstanding requests (i.e., record requests to which the provider has not responded): Providers will have 90 days from the date of the initial request to submit records.
• Second request timeframes will remain the same.
• Tufts Health Plan reserves its right to request previously agreed-upon numbers of records. If fewer records are requested from April 8, 2020 to June 1, 2020, Tufts Health Plan may increase the number of records requested in subsequent months by a commensurate amount.

In-process Reviews

• Vendors will complete reviews and issue findings per existing processes.
• Providers may appeal, as indicated below.

Appeals

• In-process appeals: Vendors will complete previously-submitted appeals and issue findings per existing processes.
• New appeals: Providers will have 90 days from the date of the determination to submit new appeals.
• Providers will have 90 days from the date of the appeal determination to submit second-level appeals.

Fraud Investigation

Tufts Health Plan reserves the right to conduct medical record reviews during the aforementioned time frame if there is an indication of potential fraud, waste or abuse.
 

In accordance with the Coronavirus Aid, Relief, and Economic Security (CARES) Act, CMS has suspended sequestration from May 1, 2020 through December 31, 2020. As such, Tufts Health Plan is implementing this CMS requirement and suspending the reimbursement reductions for Medicare Advantage hospital rates and professional rates for the same time period for acute care hospitals, clinicians, physicians and PCPs. CMS has now extended the suspension of the sequestration payment reduction through March 31, 2021.  Tufts Health Plan is also continuing the suspension of the sequestration payment reduction through March 31, 2021. This applies to Tufts Medicare Preferred, Senior Care Options, and Tufts Health Unify.
 

Tufts Health Plan implemented Temporary Retainer Payments pursuant to the EOHHS Managed Care Entity (MCE) Bulletin 27, for dates of service between April 1, 2020 and July 31, 2020 for Adult Day Health (ADH) providers for Tufts Health Unify and Senior Care Options (SCO) members.

Retainer payments will be paid on a per-member, per-day basis at 100% of the provider’s contracted per diem rate for ADH services where the provider has met the eligibility criteria as outlined in MCE Bulletin 27.

In order to receive retainer payments, providers must submit a per diem claim for a member for each day on which that member would have been scheduled to attend the provider’s ADH program. Claims must be submitted using one of the two appropriate codes listed in the table below and must include the modifier U6. Claims submitted without modifier U6 will be rejected.
 

Code	Modifier	Description
S5102	TG U6	Complex level of care (per diem)
S5102	U6	Basic level of care (per diem)

 
Additionally, for Tufts Health Unify only, providers must submit the encounter log to unifyltss@tufts-health.com no later than the 15^th of the following month. This log will be used to validate claims submitted in accordance with the eligibility requirements for retainer payment. ADH providers contracted through Aging Service Access Points (ASAPs) should provide the log to the ASAP no later than the 15^th of the following month.

For the duration of the COVID-19 emergency, Behavioral Health providers that do not have fax capabilities can email any clinical information to the appropriate Tufts Health Plan email address, as outlined below:

• Commercial (including Tufts Health Freedom Plans): BHPriorAuthCommercial@Tufts-Health.com
• Tufts Health Public Plans (Tufts Health Direct, Tufts Health Together MassHealth MCO Plan and Accountable Care Partnership Plans [ACPPs], Tufts Health RITogether, and Tufts Health Unify):  THPPBHRequests@Tufts-Health.com

In the email subject line, include the product name and type of service you are emailing information about.
 

Prior Authorization and Notification

Refer to the Provider Authorization Guidelines section above for behavioral health prior authorization and notification guidelines during the COVID-19 emergency.

Note: Providers are still responsible for confirming the service is covered by the individual treatment plan and the member meets medical necessity criteria for the service.

Additional Resources

Tufts Health Together – MassHealth MCO Plan and ACPPs

MassHealth has published the following frequently asked questions (FAQs) to support providers during the COVID-19 emergency:
 

• Children’s Behavioral Health Initiative (CBHI) Provider Frequently Asked Questions
• Applied Behavioral Analysis Provider Frequently Asked Questions

The Department of Public Health’s Bureau of Substance Addiction Services has also released guidance that has been codified in All Provider Bulletins from MassHealth and other regulatory guidance. Providers should consult the following Massachusetts Coronavirus Disease 2019 (COVID-19) - Providers pertinent regulatory guidance.

Note: This is not exhaustive of all COVID-19 regulatory guidance issued by MassHealth or other agencies nor does all listed guidance pertain to Tufts Health Together MCO and ACPPs.
 

Commercial Products, Tufts Health Direct and Tufts Health RITogether

• Tufts Health Plan will waive the refill limitation one-time to allow for early refills of a medication prescription prior to the expiration date, including specialty pharmaceuticals. Controlled substances are excluded from this policy.
• Maintenance medications may be refilled for up to a 90-day supply, assuming the days supply is available based on the unused portion of the prescription.

Tufts Health Together

• Per MassHealth Managed Care Entity (MCE) Bulletin 22  Tufts Health Together members may obtain a 90-day supply for all prescription drugs.
• In accordance with MassHealth MCE Bulletin 41 , prior authorization is not required for Sublocade^TM

Senior Products and Tufts Health Unify

• Tufts Health Plan allows early refills of a medication prescription prior to the expiration date, including specialty pharmaceuticals. Controlled substances are excluded from this policy.
• Maintenance medications may be refilled for up to a 90-day supply, assuming the days supply is available based on the unused portion of the prescription.

Chloroquine and Hydroxychloroquine Coverage for Commercial (including Tufts Health Freedom Plans) and Tufts Health Public Plans

• Prior authorization is required for coverage of chloroquine and hydroxychloroquine tablets for members initiating a new course of treatment. Refer to the Pharmacy Medical Necessity Guidelines for Chloroquine and Hydroxychloroquine for prior authorization requirements.
• No action is required for members who have previously been taking these drugs.

Tips for Prescribers

For information for members on Warfarin that require international normalized ratio (INR) testing, click here.

In accordance with MassHealth MCE Bulletin 39, a member’s physician, nurse practitioner, physician assistant or clinical nurse specialist may:

• Prescribe or write letters of medical necessity for DMEs and oxygen and respiratory equipment, and
• Order home health services and establish a member’s plan of care.

Personal Protective Equipment (PPE)

CPT code 99072 is designed for providers to report expenses incurred during a Public Health Emergency (PHE), including PPE, cleaning supplies and additional clinical staff time. This code is non-reimbursable for all Tufts Health Plan products.

Practitioners to Provide Services during the COVID-19 Public Health Emergency Only

• Practitioners seeking to provide care during the COVID-19 public health emergency only, but do not seek to join any Tufts Health Plan network on a more permanent basis, should complete the COVID-19 Deployment Only Enrollment Roster and submit to: Provider_Information_Dept@tufts-health.com for Commercial (including Tufts Health Freedom Plan), Tufts Medicare Preferred HMO, and Tufts Health Plan Senior Care Options (SCO) networks and Provider_Data_Request@tufts-health.com for Tufts Health Public Plans.
• Include “COVID-19 Enrollment Only” in the subject line of the email containing the completed form
• Examples of such practitioners include:
  • Retirees granted temporary licensure in order to work during the COVID-19 public health emergency
  • Recent medical student graduates who may be granted temporary licensure who are working in a hospital or facility during the COVID-19 public health emergency and have not begun their residency programs
  • Clinical fellows and clinical researchers who have been granted temporary privileges to provide care in the facility setting
  • Any out-of-network practitioners granted a temporary license to provide services in a state where Tufts Health Plan serves, and not typically their home practice state in order to work during the COVID-19 public health emergency.  Note: This category of practitioner will need to have verifications completed, including inquiry about 1135-based licensure waivers from CMS, if applicable

Practitioners Seeking to Join Tufts Health Plan Networks

• Practitioners who seek to join Tufts Health Plan networks on a more permanent basis should follow the usual contracting and credentialing processes. Refer to the Credentialing and Contracting Overview for additional information.
• The Tufts Health Plan Credentialing Department will make every effort to expedite the credentialing process.

If you have any questions regarding expedited credentialing or provisional credentialing, please contact Tufts_Health_Plan_Credentialing_Department@tufts-health.com. Providers may also refer to the Frequently Asked Questions to Tufts Health Plan’s Credentialing Department.
 

• Centers for Disease Control and Prevention (CDC)
• Massachusetts Department of Health
• Rhode Island Department of Public Health
• New Hampshire Department of Health and Human Services
• Connecticut Department of Public Health
• Cigna’s Response to COVID-19