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Medicare has approved Tufts Health Plan to administer Medicare Advantage plans. Read on for more information about how Tufts and other Advantage plans work.
Massachusetts-based Tufts Health Plan offers Medicare Advantage plans with dental coverage. In some cases, dental care is available as an add-on option. Tufts Health Plan is a nonprofit insurer.
Tufts Health Plan was a Massachusetts-based non-profit health insurance company under Tufts Associated Health Plans, Inc. with headquarters in Watertown, Massachusetts. [1] It completed a merger with Harvard Pilgrim Health Care on January 1, 2021, making the then unnamed company the second-largest health insurer in Massachusetts.
Tufts Health Plan offers the three Medigap plans in Massachusetts: Plan 1, Plan 1a, and Core. Find out what these plans cover and their cost in 2025.
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
After a request comes in from a qualified provider, the request will go through the prior authorization process. The process to obtain prior authorization varies from insurer to insurer but typically involves the completion and faxing of a prior authorization form; according to a 2018 report, 88% are either partially or entirely manual. [5]
The implementation of healthcare insurance reform began in June 2006, with the appointment of members of the Connector board and the naming of Jon Kingsdale, a Tufts Health Plan official, as executive director of the Connector. On July 1, MassHealth began covering dental care and other benefits, and began enrolling children between 200% and 300 ...
Harvard Pilgrim Health Care is a non-profit health services company based in Canton, Massachusetts serving the New England region of the United States. On August 14, 2019, the boards of Harvard Pilgrim Health Care and Tufts Health Plan announced plans for the two insurers to merge their organizations into a new company.
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related to: tufts medicare prior authorization guidelines