Tufts Medicare Preferred HMO Provider Manual - Tufts Health Plan

Tufts Medicare Preferred HMO Provider ManualPrecertificationPrecertificationCoordinatorPrecertification ClinicalStaff1-800-672-15151-800-843-3553 (fax)617-972-9409 (fax)Preregisters inpatient admissions and surgical day careservices• Reviews requests for formulary or pharmacy tieringexceptions for Tufts Medicare Preferred HMOMembersCase Management 1-888-766-9818• Concurrently reviews Tufts Medicare PreferredHMO members hospitalized at an in-plan facility.• Coordinates discharge planning, includingrehabilitation, skilled nursing facility, or chronichospital placement, home health care, hometherapies, and durable medical equipmentTufts Health Plan Medicare Preferred Provider RelationsProvider Specialist 1-800-279-9022• Addresses inquiries regarding covered benefits,claims, and Statements of Account• Confirms member eligibility• Answers general and specific provider questionsProvider Communications and EducationProvider EducationSpecialist1-888-306-6307 • Educates providers about products, policies andprocedures, self- service technology solutions• Offers the following educational programs:• Self-service training• Webinars• Onsite meetings• Ad hoc meetingsLast updated 08/2012. Chapter revision dates may not be reflective of actual policy changes.3 Tufts Health Plan Medicare Preferredtuftshealthplan.com/providers