Tufts Health Plan’s process for credentialing and contracting Allied Health (i.e., independently licensed) providers is outlined below. For Allied Health behavioral health providers, click here. This process does not apply to hospital-employed providers, physicians, or providers employed by a physician group or licensed clinic. For information on the contracting for those providers, refer to MDs, DOs, DPMs or Oral Surgeons.
Network participation is contingent upon the successful completion of the credentialing and contracting process. For applicants who submit complete application (i.e. an application with no adverse responses, no quality issues, or missing information), the credentialing and contracting process for allied health providers can take one to two 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.
To join the Tufts Health Plan provider network, providers must complete the following steps:
Step 1: Complete Application Documents
View, download and complete the specific credentialing application checklist and any additional forms and documents as outlined in the checklists below.
Note: All individually credentialed Allied Health providers must complete the CAQH application. Allied Health providers that are credentialed at the group or facility level do not need to fill out the CAQH application.
For all services, please submit the following forms: (note: additional forms may be required, see specialty.)
Step 2: Submit forms and documents
Submit forms and documents by either emailing them to [email protected] or by faxing them to 617-673-0909. To facilitate review of a provider's application, submit all materials together.
Step 3: Enrollment and Contract Execution
Tufts Health Plan receives daily notifications when providers have successfully completed the credentialing process and have been approved to join the Tufts Health Plan network(s). Within 30 days, Tufts Health Plan will send a fully executed contract to the provider, via email, communicating the in-plan effective date and welcome packet information, including claims submission information.
Point32Health is the parent organization of Harvard Pilgrim Health Care and Tufts Health Plan. Together, we're delivering ever-better health care experiences to everyone in our diverse communities.