How to Submit a Superbill to Tufts Health Plan for Therapy Reimbursement

Tufts Out-of-Network Process

Tufts Health Plan, now part of Point32Health, serves members in Massachusetts, Rhode Island, and New Hampshire. OON mental health benefits are available on PPO and POS plans. Members submit superbills through the Tufts member portal at tuftshealthplan.com or by mailing the claim form with the superbill attached. Behavioral health claims are processed by Tufts's integrated behavioral health department.

Common Denial Reasons

• ✗Member has a Tufts HMO plan with no OON mental health benefits
• ✗Provider is not licensed in Massachusetts, Rhode Island, or New Hampshire
• ✗Claim submitted without prior authorization when the plan requires it for outpatient mental health
• ✗Superbill missing provider DEA number when billing for medication management codes

Tips for Getting Reimbursed by Tufts

• ✓Tufts PPO and POS members typically have strong OON mental health benefits — verify at intake
• ✓Point32Health merged Tufts and Harvard Pilgrim — some members have migrated to combined ID cards
• ✓Massachusetts mental health parity laws provide strong protections for OON therapy reimbursement
• ✓Include your CAQH profile information on the superbill to speed up provider verification at Tufts