Tufts Medicare Preferred HMO Provider Manual - Tufts Health Plan
Tufts Medicare Preferred HMO Provider Manual - Tufts Health Plan
Tufts Medicare Preferred HMO Provider Manual - Tufts Health Plan
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<strong>Tufts</strong> <strong>Medicare</strong> <strong>Preferred</strong> <strong>HMO</strong> <strong>Provider</strong> <strong>Manual</strong>Department Contact ResponsibilityNetwork Management and ContractingNetwork Contracting andPerformance Management(NCPM)Allied <strong>Health</strong> Services.888-880-8699 x2169 • Contract Manager617-972-9411− Negotiates and executes contracts for <strong>Tufts</strong><strong>Medicare</strong> <strong>Preferred</strong> <strong>HMO</strong> medical groups,providers and hospitals.• Associate Contract Specialist− Processes operational changes• Contract Specialist− Monitors <strong>Tufts</strong> <strong>Medicare</strong> <strong>Preferred</strong> <strong>HMO</strong>medical group and hospital performance.− Fosters and maintains medical grouprelationships− Ensures contracts are implemented in theappropriate <strong>Tufts</strong> <strong>Health</strong> <strong>Plan</strong> systemsAllied <strong>Health</strong> Contract Administrator• Negotiates and administers contracts for allancillary services, skilled nursing facilities,inpatient rehabilitation hospitals, and home careservices• Evaluates prospective ancillary providers andassesses need for additions and changes to thecontracting provider network• Monitors contract compliance and performsutilization review of contracts• Keeps abreast of federal and state regulatorylicensing and credentialing information for allancillary services, skilled nursing facilities,inpatient rehabilitation hospitals, and home careservices• Recommends necessary revisions to contracts• Responds to questions regarding ancillary providersand available servicesDepartment Contact Responsibility<strong>Provider</strong> Credentialing1-888-306-6307<strong>Provider</strong> Credentialing SpecialistMaintains practitioner credentialing /recredentialing process.<strong>Provider</strong> Information1-888-306-6307<strong>Provider</strong> Information Specialist• Facilitates change of provider application• Facilitates change of provider practice or paymentinformation2 <strong>Tufts</strong> <strong>Health</strong> <strong>Plan</strong> <strong>Medicare</strong> <strong>Preferred</strong>tuftshealthplan.com/providers
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