Providers should confirm member benefits prior to rendering services. Members are covered as described in their benefit document. Providers can obtain specific benefit information by:
- Logging in to the secure provider website
- Using the Interactive Voice Response (IVR) system by calling 1 (800) 208-9565
- Speaking to a Behavioral Health Service Coordinator at 1 (800) 547-5186
The Behavioral Health Department is open Monday, Tuesday, Wednesday and Friday from 8:30 a.m. – 5 p.m. and Thursday from 9 a.m. – 5 p.m.
Outpatient coverage includes behavioral health and substance use disorder treatment, medication, evaluation, and monitoring. The behavioral health and substance use disorder provider is responsible for obtaining the necessary authorization. PPO members do not require notification.
For more information, refer to the Outpatient Behavioral Health/Substance Use Disorder Professional Payment Policy.
Inpatient and Intermediate Care
Inpatient and Intermediate level of Care coverage is provided at a Tufts Health Plan participating provider. This coverage includes acute residential treatment programs, partial hospitalization programs and intensive outpatient programs.