CommercialAdministrativeMedium impact
Point32Health Payment Policy updates
Harvard Pilgrim Health Care·Gastroenterology, Ophthalmology, Optometry +3 more·Reimbursement
Effective date
Nov 1, 2025
We identified it
Jun 20, 2026
Summary
Point32Health has consolidated and updated multiple payment policies across Harvard Pilgrim and Tufts Health Plan products, creating integrated policies for gastroenterology and vision services while making administrative updates to evaluation and management, drugs and biologicals, DME, orthotics/prosthetics, dental care, and behavioral health policies. All changes take effect November 1, 2025.
Action Required
By November 1, 2025: Billing team must access the Point32Health provider website Payment Policies section to review all updated policies, particularly the new integrated gastroenterology and vision policies that replace separate Harvard Pilgrim and Tufts policies. Update billing system references to reflect Point32Health branding and verify compliance with new policy language for dental care state mandates and behavioral health billing guidance for RITogether providers.