Medicare AdvantageDocumentationHigh impact
Reminder for SNFs: Submit SC-1 forms to Tufts Health Plan and MassHealth
Harvard Pilgrim Health Care·MA · Geriatrics, Palliative Care·Provider Newsletter
We identified it
Jun 26, 2026
Summary
Tufts Health Plan and MassHealth require SNFs to submit SC-1 (Status Change) forms for all admissions of 2+ months for members enrolled in Senior Care Options (SCO) or One Care plans. Forms must be submitted to both MassHealth Enrollment Center and Tufts Health Plan upon admission and when status changes. Timely submission is critical for accurate claims processing, as MassHealth must update member records in MMIS before Tufts can process claims.
Action Required
Immediately: SNF billing teams must implement SC-1 form submission procedures for all Tufts Health Plan Senior Care Options (SCO) and One Care admissions lasting 2+ months. Specific actions required: (1) For custodial care (short-term, member returning home): Submit SC-1 to MassHealth Enrollment Center AND Tufts Health Plan (SCO: Fax 617-673-0781; One Care: Fax 617-673-0926 Attn: Membership Accounting Department) upon admission and discharge. (2) For long-term stays (SNF as member's residence): Submit SC-1 upon admission and within 5 business days of any status changes to MassHealth Enrollment Center AND Tufts Health Plan (SCO: Fax 617-673-0926 Attn Membership Accounting Dept OR email Membership_Accounting_SCO_Reconciliation@point32health.org; One Care: Fax 617-673-0926 Attn Membership Accounting Dept OR email THP_One_Care_SC-1_Submission@point32health.org). (3) Do NOT submit SC-1 for skilled care stays under 2 months. (4) If claims are delayed, billing staff must verify MDS Level of Care (LOC) is on file in MMIS; if not, contact MassHealth directly. If LOC is on file but claims remain delayed, contact Membership_Accounting_SCO_Reconciliation@point32health.org. Failure to submit SC-1 timely will result in delayed claims processing and potential claim denials.