Tufts Health Plan
Welcome to the Tufts Health Plan Health Plan page. Here you can download policies and procedures specific to both ordering and rendering providers. These include quick reference guides and information designed to assist you in using RadMD to request and check the status of prior authorizations.
If you have any questions about our programs, please contact your dedicated NIA Provider Relations Manager, April Sabino.
Effective November 1, 2016
Massachusetts Imaging Prior Authorization Form
- Tufts Health Plan Utilization Review Matrix-2022 - updated 7/1/2022
Codes highlighted in yellow do not require pre-authorization or medical necessity review for members under 18 years.
Spine Management and Joint Surgery
- Interventional Pain Management Checklist
- Spine Care Program Interventional Pain Management Frequently Asked Questions
- Spine Care Program Spine Surgeries Frequently Asked Questions
- Spine Management Provider Training
- Spine Pain Management Quick Reference Guide for Ordering Physicians/Surgeons
- Spine Surgery Checklist
- Tufts Health Plan Joint Surgery Provider Training PPT
- Tufts Health Plan FAQ - Joint Surgery
- Tufts Health Plan Ordering Provider QRG Joint Surgery
- Tufts Health Plan Hip Knee Shoulder Surgery Utilization Review Matrix 2022
- Tufts Health Plan Spine Surgery Utilization Review Matrix 2022
- Tufts Health Plan IPM Utilization Review Matrix 2022
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
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
RadMD is a user-friendly, real-time tool offered by Magellan Healthcare that provides ordering and rendering providers with instant access to prior authorization requests for specialty procedures. Whether submitting exam requests or checking the status of prior authorization requests, providers will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by program:
Recorded General Trainings
We have a series of training videos that discuss the components of requesting a prior authorization request. Click here to access these videos.
Recorded RadMD Demos
Need additional help using RadMD? Click here to access a series of RadMD demos that demonstrate how to properly submit a prior authorization request.
- Clinical Guidelines
Refer to the Utilization Review Matrix document to view specific codes managed by NIA
Clinical Training Modules
We have a series of clinical training modules that will help you avoid delays and ensure that you have the right information before submitting your prior authorization request. Click here to access them.
Update on COVID-19
Click here to view our recommendations on the use of CT to detect Coronavirus (COVID-19).