New - interim billing for medical inpatient stays

Point32Health is pleased to share that we’re now accepting interim claims for all medical inpatient stay types, as appropriate, for Tufts Health Together, Tufts Health One Care (HMO D-SNP), and Tufts Health Plan Senior Care Options members. This means that providers no longer have to wait until a patient discharges before submitting claims. Interim claims can now be billed for members receiving a continuous course of inpatient treatment that’s expected to last for an extended period of time. 

For admission dates on or after July 1, 2024, providers can submit a bill for services every 60 days using the bill types below.

Please note that interim bill types 113 and 114 are not allowed for medical inpatient stays.

It’s important to keep in mind that each interim bill for a single inpatient stay should be a cumulative bill of all services provided to the member. The initial interim bill is submitted for the first 60 days of the stay and any subsequent bills are submitted in 60-day intervals, except for the final bill, which is submitted upon discharge and cumulatively reflects all of the services provided throughout the course of the stay — thus replacing the previous bills.

We’ve updated our Inpatient Hospital Admissions Payment Policy to include information on interim billing for Tufts Health Together, Tufts Health One Care, and Tufts Health Plan Senior Care Options plans. Additional claims guidance can be found within the Claims Requirements section of the Tufts Health Public Plans and Senior Products Provider Manuals.