CommercialAdministrativeMedium impact
Utilization management best practices and tips
Harvard Pilgrim Health Care·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Point32Health (Harvard Pilgrim/Tufts) issued updated best practices for utilization management requests, emphasizing use of electronic portals for prior authorizations and eligibility verification. Key change: MHK portal access will expand to Tufts Health One Care members starting January 1, 2026.
Action Required
By January 1, 2026: Staff working with Tufts Health One Care members must transition to using the MHK portal for all prior authorization submissions, referrals, and claim status inquiries. Train billing team on MHK portal functions including real-time determinations and clinical documentation attachment. Ensure all authorization requests include complete clinical documentation, provider NPI/TIN, and relevant identifying information to avoid resubmission delays.