Medicare AdvantagePrior AuthMedium impact
Vendor program reminder and notification timeframe clarification
Harvard Pilgrim Health Care·MA · Family Medicine, General Practice, Internal Medicine +1 more·Provider Newsletter
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
Tufts Medicare Preferred has clarified notification requirements for home health services under their partnership with Home and Community Care Transitions. Providers must notify within 5 days of start of care, with prior authorization required after the first 30 days.
Action Required
Immediately: Billing team must establish workflow to notify Home and Community Care Transitions within 5 days of start of care for all Tufts Medicare Preferred home health patients in Massachusetts. Update scheduling system to track notification deadlines. Set up prior authorization requests for home health services continuing beyond 30 days. Failure to notify or obtain required prior authorization may result in claim denials.