Tufts Health Plan
Welcome to the Tufts Health Plan page. Here you can download policies and procedures specific to both ordering providers and imaging facilities. These include quick reference guides and FAQs. You can also view information designed to assist you in using the RadMD Web site to obtain and check authorizations.
Effective November 1, 2016
Massachusetts Imaging Prior Authorization Form
http://www1.radmd.com/authorizations/state-authorization-requirements-and-clinical-criteria.aspx
Documents
- OCR Fax Coversheet (PDF 145K)
- Tufts Health Plan / NIA CPT Code Matrix (PDF 254K)
Codes highlighted in yellow do not require pre-authorization or medical necessity review for members under 18 years.
- RadMD for Ordering and Imaging Providers (PDF 96K)
- RadMD Pain Managment (Injection) Quick Start Guide (PDF 349K)
- RadMD Pain Managment (Surgery) Quick Start Guide (PDF 504K)
- RadMD Quick Start Guide (PDF 40K)
- RadMD Upload Feature (PDF 436K)
Clinical Guidelines
- Clinical Guidelines
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Refer to the Utilization Review Matrix document to view specific codes managed by NIA
Spine Management and Joint Surgery
- Changes to Spinal Conditions Management Program (PDF 58K)
- Interventional Pain Management Checklist (PDF 661K)
- Spine Care Program Interventional Pain Management Frequently Asked Questions (PDF 262K)
- Spine Care Program Spine Surgeries Frequently Asked Questions (PDF 309K)
- Spine Management Provider Training (PDF 1,562K)
- Spine Pain Management Quick Reference Guide for Ordering Physicians/Surgeons (PDF 233K)
- Spine Surgery Checklist (PDF 479K)
- Tufts Health Plan Joint Surgery Provider Training PPT
- Tufts Health Plan FAQ - Joing Surgery
- Tufts Health Plan Ordering Provider QRG Joint Surgery
- Tufts Health Plan Spinal Conditions Management and Join Surgery Utilization Review Matrix
- Spine Surgery Authorization and Coding Reference Guide (PDF 312K)
- Hip Knee and Shoulder Authorization and Coding Reference Guide (PDF 312K)
Cardiac Management Effective 1/1/2017
Tufts Health Plan expanded their cardiac study prior authorization program to include Cardiac Catheterizations, Echocardiography, Stress Echocardiography, and Implantable Cardiac Devices effective January 1, 2017.
- Tufts Health Plan Cardiac Frequently Asked Questions
- Tufts Health Plan Ordering Provider Quick Reference Guide
- Tufts Health Plan Imaging Provider Quick Reference Guide
- Tip Sheet
- Tufts Health Plan MPI vs Stress Echo Tip Sheet
- Tufts Health Plan Cardiac Provider Training PPT
- RadMD Quick Start Guide
- RadMD Upload Feature
- RadMD for Ordering and Imaging Providers