Insights and Updates for Providers

We’ve developed a guide to navigating pre-service clinical appeals that provides an overview of Point32Health’s UM appeals options and step-by-step submission instructions.

For dates of service beginning April 1, 2026 for Harvard Pilgrim Commercial, Point32Health will apply level of care reviews to elective inpatient medical admissions.

Effective May 1, 2026 for certain Harvard Pilgrim Commercial and Tufts Health Direct members, the automated step therapy program will be removed for diabetic GLP-1 and GIP/GLP-1 medications.

We would like to congratulate the 34 physician groups in Harvard Pilgrim’s Commercial network named to our 24th annual Physician Group Honor Roll. 

Beginning Jan. 1, we will honor existing authorizations from in-network providers when a patient switches to Harvard Pilgrim or Tufts Health Direct from another insurer.

We’re now accepting interim claims for all medical inpatient stay types for Tufts Health Together, Tufts Health One Care, and Tufts Health Plan Senior Care Options members.

As you may know, Point32Health covers annual behavioral health wellness exams with no member cost sharing or prior authorization required for our Tufts Health Together and Tufts Health Direct members, which may be rendered by a primary care provider or licensed mental health professional. 

We’re offering some important reminders around the correct billing practices for short-term behavioral health (BH) inpatient stays.

Use our secure provider portals for ease and convenience, and as a reminder, you can now use MHK for Tufts Health One Care members!