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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<strong>Introduction</strong> <strong>to</strong> <strong>Tufts</strong> <strong>Health</strong> <strong>Plan</strong>Department Contact ResponsibilityPreferred Provider Organization(PPO) Member Services Specialist1-800-423-8080 • For <strong>Tufts</strong> <strong>Health</strong> <strong>Plan</strong> members onlyRhode Island–Based EmployerGroups Member Services Specialist1-800-682-8059 • For members <strong>of</strong> Rhode Island basedemployer groupsNetwork Contracting and Performance ManagementContract Manager 1-888-880-8699 ext. 2169 • Negotiates contracts with providerorganization leadershipContract Specialist 1-888-880-8699 ext. 2169 • Ensures contract terms are implemented inappropriate <strong>Tufts</strong> <strong>Health</strong> <strong>Plan</strong> systems• Fosters and maintains provider networkrelationshipAssociate Contract Specialist 1-888-880-8699 ext. 2169 • Processes operational changesNetwork ManagementProvider Information Specialist 1-888-306-6307 • Facilitates change <strong>of</strong> provider practice orpayment information status• Facilitates provider terminationsProvider Credentialing Specialist 1-888-880-8699 • Processes new credentialing andrecredentialing applications for providersand certain ancillary providers (includingindependent licensed practitioners andorganizational providers, such as acutehospitals, rehabilitation hospitals,freestanding surgical centers, and others)and verifies completeness <strong>of</strong> theapplication.Provider ServicesProvider Specialist 1-888-884-2404 Providers should call this number for thefollowing issues:• Inquiries regarding paid or in-processclaims• Interpretation <strong>of</strong> member benefits4 <strong>Tufts</strong> <strong>Health</strong> <strong>Plan</strong>tuftshealthplan.com/providers
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