MedicaidPrior AuthHigh impact
CHA Referral Requirement Reminder
Harvard Pilgrim Health Care·Provider Newsletter
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
Effective July 1, 2026, Tufts Health Together members with Cambridge Health Alliance (CHA) ACO will require referrals from their primary care providers for all specialty services outside of the CHA network. Claims for services requiring referrals will be denied if no referral is submitted.
Action Required
Before July 1, 2026: Billing team must implement referral verification process for all Tufts Health Together CHA ACO members seeking specialty services outside CHA network. Update billing system to flag these patients and require referral confirmation before scheduling. Train front desk staff to verify referral status through Tufts provider portal or by calling Provider Service Center. Claims will be denied without proper referrals.