MDs, DOs, DPMs or Oral Surgeons
Tufts Health Plan's process for credentialing and contracting hospital-employed providers, physicians, or providers employed by a physician group or licensed clinic are outlined below. For information on contracting independently licensed behavioral health (BH) providers, refer to Behavioral Health Allied Health Providers. For all other allied health providers, click here.
Network participation is contingent upon the successful completion of the credentialing and contracting process. For applicants who submit a clean and complete application (i.e. an application with no adverse responses, no quality issues, or missing information), the credentialing and contracting process for can take up to three months. Applications that are not clean and complete may experience a lengthier application process until all the necessary information is provided. The network effective date is the approval date of the credentialing application or the effective date of the signed contract; whichever is later. Providers are notified once the approval process is complete. Incomplete or illegible applications will extend the overall contracting timeframes. Refer to the Additional Information page for clean and complete credentialing application requirements.
MDs, DOs, DPMs or oral surgeons who participate in an IPA or PHO and are interested in contracting with Tufts Health Plan should complete the following steps:
Step 1: Contact the Provider Unit or IPA/PHP Administration of the hospital with which they are affiliated to obtain a contract for review and signature.
Step 2: Once the contract is signed, complete HealthCare Administrative Solutions (HCAS) Provider Enrollment Form.
Step 3: For Tufts Health Plan Commercial, Senior Products, and Public Plans, submit the contract and enrollment form to: Provider_Information_Dept@point32health.org
Step 4: Complete the credentialing application on the CAQH website.
Note: For Tufts Health Public Plans products, also complete the Provider Information Data Form.
MDs, DOs, DPMs or oral surgeons who do not participate in an IPA or PHO and are interested in contracting with Tufts Health Plan may be eligible to join Tufts Health Plan through an independent contract.
Step 1: Submit Credentialing Application
Providers must submit their credentialing application to CAQH ProView. CAQH applications in CAQH ProView with a status of Initial Profile Complete or Reattestation are available to move to the credentialing process. Any other status in CAQH ProView indicates an incomplete application and must be updated and reattested.
Include an explanation for any positive responses to questions regarding licensure and prescriptive practices, as well as the five-year work history section in month/year format.
Note: If the CAQH registration process has previously been completed, log in to update any information that has changed since the last attestation and authorize the release of data to Tufts Health Plan.
Step 2: Request to join the Tufts Health Plan Network(s)
Email a completed Provider Information Data Form (for Tufts Health Public Plans products) or the HCAS Provider Enrollment Form (for Commercial and Senior Products), and W9 to: Provider_Information_Dept@point32health.org
Step 3: Contract and Credentialing Process
Tufts Health Plan reviews the application, generates a contract specific to the products intended to join and will email the contract to the primary method of contact. The contract should be reviewed, signed and sent back to Tufts Health Plan to initiate credentialing.
Tufts Health Plan’s Credentialing Department cannot process the application until all required materials are received including the HCAS Provider Enrollment Form and Provider Information Data Form. Providers will be notified by email if the application cannot be processed due to incomplete information.
Allow approximately 30 days for processing after the completed application and documents are received by Tufts Health Plan. Providers may check the application status during this time by sending an email to: Provider_Information_Dept@point32health.org
Step 4: Approval Process
Once the application is approved, a welcome letter will be sent via email and will include the effective date for seeing Tufts Health Plan members, and additional useful resources, including claims submission information.
For other resources and important information, visit the HCAS website.