Introduction to Tufts Health Plan Purpose of This Manual
Introduction to Tufts Health Plan Purpose of This Manual
Introduction to Tufts Health Plan Purpose of This Manual
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<strong>Introduction</strong> <strong>to</strong> <strong>Tufts</strong> <strong>Health</strong> <strong>Plan</strong>Department Contact ResponsibilityClinical ServicesCase ManagementCare Manager1-888-766-9818 • Concurrently reviews <strong>Tufts</strong> <strong>Health</strong> <strong>Plan</strong>members hospitalized at <strong>Tufts</strong> <strong>Health</strong> <strong>Plan</strong>facilities• Coordinates and authorizes discharge plans,including rehabilitation, Skilled NursingFacility (SNF) or chronic hospitalplacement, home health care, hometherapies, and Durable Medical Equipment(DME)Specialty Care Manager 1-888-766-9818 • Facilitates discharge planningMental <strong>Health</strong> Department• Provides ongoing coordination <strong>of</strong> servicesthrough the continuum <strong>of</strong> illness <strong>of</strong>medically complex cases• Acts as plan liaison for members, families,providers and vendors <strong>of</strong> ancillary services• Manages medically complex cases• Performs out-<strong>of</strong>-network hospital reviewsand discharge planning• Manages high-risk obstetrics, pediatrics,neona<strong>to</strong>logy, transplants, HIV/AIDS,disabilities, rehabilitation nursing, andoncology casesMental <strong>Health</strong> Outpatient ClinicalCoordina<strong>to</strong>r and ServiceRepresentative1-800-208-9565 • Manages requests for outpatient mentalhealth and substance abuse (MH/SA)services• Coordinates members’ access <strong>to</strong> inpatientMH/SA servicesMental <strong>Health</strong> Care Manager 1-800-208-9565 • Facilitates discharge planning for membershospitalized at Designated Facilities (DFs)Precertification Department• Moni<strong>to</strong>rs quality <strong>of</strong> care at mental healthDFsPrecertification Clinical Staff 617-972-9409 (fax) • Coordinates any federal mandates• Authorizes utilization management <strong>of</strong>certain outpatient procedures including, butnot limited <strong>to</strong>, elective surgeries, selectedmedication, and experimental procedures2 <strong>Tufts</strong> <strong>Health</strong> <strong>Plan</strong>tuftshealthplan.com/providers