How to Submit a Superbill to Tufts Health Plan

Tufts Health Plan — now operating as Point32Health alongside Harvard Pilgrim — is the leading regional insurer for New England. Submitting an OON therapy superbill to Tufts is a well-supported process with strong mental health benefits across Massachusetts and Rhode Island.

Overview: Tufts Health Plan and Out-of-Network Mental Health Benefits

Tufts Health Plan merged with Harvard Pilgrim Health Care in 2021 to form Point32Health, though both brands continue to operate independently. Tufts Health Plan serves members primarily in Massachusetts, Rhode Island, Connecticut, and New Hampshire. Most Tufts commercial (employer-sponsored) and individual plans include OON mental health benefits under PPO plans, often with better rates than large national carriers.

Massachusetts has strong mental health parity enforcement, and Tufts is known for competitive OON mental health reimbursement rates. The merger with Harvard Pilgrim has not changed the Tufts brand or member experience — you still use the Tufts portal at tuftshealthplan.com. For more context on the general process, see our step-by-step superbill submission guide. For a full overview of Tufts coverage, visit our Tufts Health Plan insurance guide.

Tufts processes OON behavioral health claims through its standard claims department. Most PPO plans do not require a referral for OON mental health services, but confirm your plan's specific requirements before beginning treatment.

Step-by-Step Process for Submitting to Tufts Health Plan

1. Get your superbill from your therapist. Request a superbill covering all sessions you want to submit. Tufts accepts batch submissions covering multiple dates of service on one claim.
2. Log in to your Tufts member account. Go to tuftshealthplan.com and sign in with your member credentials. Navigate to the claims section and select Submit a Claim. This is the fastest and most reliable method.
3. Complete the online claim form. Tufts will ask for provider name, dates of service, CPT codes, and amounts charged. Upload the superbill PDF as supporting documentation.
4. Alternative: mail your claim. Download the Tufts OON claim form from tuftshealthplan.com and mail it with your superbill to the claims address on your ID card. Use certified mail for your records.
5. Note your confirmation number. After online submission, screenshot the confirmation page. After mailing, retain the certified mail receipt.

What to Include With Your Tufts Claim

Tufts requires the superbill to contain all required superbill fields. Specifically for Tufts, confirm your superbill includes:

• Provider full name, NPI (Type 1), and practice address
• Provider Tax ID (EIN or SSN) and professional license number
• Your name, date of birth, and Tufts member ID number
• Date(s) of service
• CPT procedure code (e.g., 90837 for 60-minute therapy) and description
• ICD-10 diagnosis code (e.g., F41.1 for generalized anxiety)
• Place of service code (11 for office; 10 for telehealth)
• Fee charged per session and amount you have already paid

Tufts's Processing Timeline

Tufts typically processes OON mental health claims within 30–40 days of receipt. Online submissions are received immediately; mailed claims add several days for postal transit. You will receive an Explanation of Benefits (EOB) in your Tufts portal before any payment is issued. Payment arrives by check or direct deposit if configured.

Tufts's filing deadline for most commercial plans is 180 days from the date of service. Submit promptly to avoid deadline issues.

Common Issues When Submitting to Tufts

• HMO plan limitations: Tufts HMO members generally cannot receive OON reimbursement for routine outpatient therapy. Verify your plan type (PPO vs. HMO) before submitting.
• Point32Health brand confusion: Since the Harvard Pilgrim merger, some members receive communications mentioning "Point32Health" but should still use the Tufts portal. If you have a Tufts member ID card, use tuftshealthplan.com.
• Missing NPI: Tufts will reject claims without a valid provider NPI. Confirm your therapist's NPI is Type 1 (individual) and matches the NPI Registry.
• Duplicate submission: Submitting online and by mail for the same dates of service will create a duplicate and delay processing. Choose one method.

Tips for a Smooth Tufts Claim

• Call Member Services before your first claim to verify OON deductible, coinsurance rate, and any plan-specific requirements for mental health services.
• Use the tuftshealthplan.com member portal to track claim status after submission.
• Massachusetts's mental health parity laws give you strong appeal rights if your claim is denied. The Massachusetts Division of Insurance can assist if internal appeals fail.
• Submit monthly in batches rather than after every session to reduce administrative overhead and keep submission dates easy to track.

Superbilled makes it easy to generate Tufts-ready superbills with all required fields pre-filled. Once your therapist sends you the superbill, you can submit directly to Tufts Health Plan through the tuftshealthplan.com portal or by mail using the steps above.