Introduction to Tufts Health Plan Purpose of This Manual
Introduction to Tufts Health Plan Purpose of This Manual
Introduction to Tufts Health Plan Purpose of This Manual
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Commercial Provider <strong>Manual</strong>Department Contact ResponsibilityPrecertification Coordina<strong>to</strong>r 1-800-672-1515 • Preregisters inpatient admissions forcommercial members and assigns an initialapproved length <strong>of</strong> stay per the Thompsontable.Liability and Recovery• Preregisters inpatient services for <strong>Tufts</strong>Medicare Preferred HMO members.Coordination <strong>of</strong> Benefits (COB) 617-972-1098 • Investigates and verifies dual healthcoverageMember Services• Determines primary and secondarycoverage• Investigates and verifies workers’compensation claims• Adjusts coordination <strong>of</strong> benefits, workers’compensation, and <strong>Tufts</strong> <strong>Health</strong> <strong>Plan</strong>Medicare• Complement (TMC) claims• For additional information, refer <strong>to</strong> ourCOB Payment Policy on our website.<strong>Health</strong> Maintenance Organization(HMO)/Point <strong>of</strong> Service (POS)Member Services SpecialistUniformed Services Family <strong>Health</strong><strong>Plan</strong> (USFHP) Member ServicesSpecialist1-800-462-0224 • For <strong>Tufts</strong> <strong>Health</strong> <strong>Plan</strong> members only• For all products, the member specialist:- Addresses inquiries from membersregarding paid or in-process claims andExplanations <strong>of</strong> Payment (also known asStatements <strong>of</strong> Account)- Interprets member benefits- Answers member questions regardinggeneral use <strong>of</strong> plan- Assists members with choice or change <strong>of</strong>primary care provider (PCP)- Confirms member eligibility- Addresses member problems or complaints1-800-818-8589 • For USFHP members and providersCommonwealth <strong>of</strong> Massachusetts,GIC Member Services Specialist1-800-870-9488 • For Commonwealth <strong>of</strong> Massachusetts, GICmembers only3 <strong>Tufts</strong> <strong>Health</strong> <strong>Plan</strong>tuftshealthplan.com/providers
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