---
title: Tufts Health Together ABA coverage (ACPPs only, since the 1/1/2026 MCO discontinuation).
url: "https://carelu.com/payers/tufts-health-together"
markdown_url: "https://carelu.com/payers/tufts-health-together.md"
state: MA (Massachusetts)
payer: Tufts Health Together (Point32Health)
kind: Medicaid managed care plan (MCO)
parent_program: MassHealth
description: "How Tufts Health Together (Point32Health) administers MassHealth ABA — the only plan family with self-managed behavioral health: its own ABA PA form instead of the state standard form, InterQual SmartSheets, a new medical-necessity guideline effective 1/1/2026, and an ABA accreditation requirement."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Tufts Health Together ABA coverage (ACPPs only, since the 1/1/2026 MCO discontinuation).

_Payer Guide · Tufts Health Together · Last updated September 2026 · 10 primary sources_

> MCO product discontinued 1/1/2026 — only its 2 ACPPs (w/ Cambridge Health Alliance, w/ UMass Memorial) remain.

Effective January 1, 2026, MassHealth discontinued the Tufts Health Together Managed Care Organization (MCO) product (All Provider Bulletin 410); members previously enrolled in the MCO were reassigned, where possible, to the health plan participating with their existing PCP. Tufts Health Together now exists only as two Accountable Care Partnership Plans — with Cambridge Health Alliance and with UMass Memorial Health — which remain active and are the only Tufts Health Together products for intake to route to. Tufts Health Together is (and remains) the only MassHealth plan family that self-manages behavioral health: no Carelon, no Optum — Point32Health's internal UM reviews ABA against its own medical-necessity guideline using InterQual criteria and SmartSheets, on Point32Health's own ABA PA form rather than the Massachusetts standard form every other administrator takes.

This plan administers the **MassHealth** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [MassHealth (Massachusetts Medicaid) guide](https://carelu.com/payers/masshealth-massachusetts-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: Point32Health provider services and the Tufts Health Together ABA Medical Necessity Guideline — the October 2025 update names the Point32Health ABA prior-authorization form for Together members but does not say whether the assessment codes themselves are separately authorized. (point32health.org serves HTML in place of its PDFs, so the MNG needs human retrieval.)
- **Prior auth for treatment:** Not published / unverified. Verify via: Point32Health provider services and the Tufts Health Together ABA Medical Necessity Guideline. NOTE: the October 2025 Point32Health update lists fax 888-977-0776 under Tufts Health DIRECT members and publishes no fax number for Tufts Health Together — confirm the Together submission channel before faxing.
- **Autism diagnosis required?**: Yes — ASD; covers sole-diagnosis Down syndrome effective 1/1/2026 (incl. Tufts Health Together) [3]

## At a glance

- **Plan status:** MCO product discontinued 1/1/2026 — only the 2 ACPPs (Cambridge Health Alliance, UMass Memorial) are active
- **Plan type:** 2 ACPPs only: with Cambridge Health Alliance, with UMass Memorial Health
- **BH administrator:** Internal — Point32Health UM (no external BH vendor)
- **PA form:** Point32Health's OWN ABA PA form — NOT the MA standard form (as of Oct 2025)
- **Clinical criteria:** Point32Health ABA MNG; InterQual + SmartSheets; new MNG effective 1/1/2026
- **Submission:** Electronic with form uploaded, or precert fax 888-977-0776
- **Network gate:** ABA provider accreditation requirement rolling out (nationally recognized accrediting body)

## The Point32 machinery

Per the October 2025 provider update, Tufts Health Together adopted InterQual criteria with InterQual SmartSheets for ABA prior-authorization review, with a new ABA medical-necessity guideline effective January 1, 2026 — and moved members onto Point32Health's own updated ABA PA form. Requests submit electronically with the form uploaded, or by fax to 888-977-0776. For a practice running one MA workflow, this is the exception to build: a Tufts Together family means the Point32 form and the Point32 portal, and a standard-form packet sent here is a bounce. The benefit itself matches the state baseline — no published hour caps, and sole-diagnosis Down syndrome coverage effective January 1, 2026 explicitly includes Tufts Health Together. [3][1][2]

## Two gates beyond the auth

Point32Health is rolling out an ABA provider accreditation requirement — accreditation by a nationally recognized ABA accrediting body — across its Harvard Pilgrim and Tufts Health Plan products, making accreditation a network-participation gate, not a quality nicety. Budget the accreditation timeline into any Tufts network strategy. Worth knowing on the enforcement front: Point32Health formally disputed MassHealth's 2026 ABA supervision-audit methodology (February 9, 2026) — but the statewide 1:10 expectation still makes supervision staffing the safe operating assumption. [3][8]

## Intake gates

The questions that decide whether a family can start with Tufts Health Together (Point32Health), and what they have to bring.

- **Age limit**: EPSDT sets the bound, and nothing else does. ABA is covered for MassHealth Standard and CommonHealth members under 21, and for Family Assistance members under 19 — with no lower age bound and no dollar, visit or unit-of-service cap underneath it. For the youngest referrals the binding rule is non-duplication rather than age: ABA cannot duplicate services the child already receives through Early Intervention. From 1/1/2026 the second diagnostic pathway (sole-diagnosis Down syndrome) rides the same age structure. Confirm the member is on one of the two surviving ACPPs — the Together MCO product was discontinued 1/1/2026. [9]
- **Prior-auth decision time**: The legal maximum is 7 calendar days, but Point32Health's manual still prints 14. Its 2026 Utilization Management chapter (last revised 4/7/2026) says "Prospective non-urgent requests will be completed within 14 calendar days" for Tufts Health Together. Urgent requests are decided "not later than 72 hours of receipt of the request," with a possible 14-calendar-day extension. The federal managed-care rule, for rating periods that start on or after 1/1/2026, caps standard decisions at "7 calendar days after receiving the request for service," plus up to 14 more calendar days on request or with justification. WellSense and Carelon moved their MassHealth decisions to 7 days on January 1, 2026, and the federal limit is the one that binds. Point32Health asks providers to "Submit a prior authorization request at least five business days in advance of the scheduled procedure, service, or planned admission." For reauthorization, file at least that far before the current authorization ends. The provider "must have this authorization letter before providing any service(s) requiring an authorization." [11][12][13][14][15]
  - Ask the plan: Point32Health utilization management: confirm it applies the 7-calendar-day standard for Tufts Health Together requests received from 1/1/2026 (the 2026 manual still says 14).
- **Other insurance (who pays first)**: Tufts Health Together pays last. "Federal and state regulations mandate that as a Medicaid managed care organization, Tufts Health Public Plans is payer of last resort for Tufts Health Together." Providers "must submit the claim(s) to all known available carriers as the primary insurer and receive an explanation of payment or equivalent." They then submit to Tufts with that EOP. The EOP must show the processed or check date and explain any remark codes. "Do not take a cost-sharing amount up front." An administrative denial from the primary carrier (a claim-preparation error, or missing information) "is not accepted as a reason for Tufts Health Public Plans to pay as a primary carrier." A COB claim is due "60 calendar days from the date on the original primary carrier's EOP." MassHealth's own rule adds that a primary denial for missing PA or for being out of network forfeits the secondary payment (130 CMR 450.316(B)). TRICARE pays before MassHealth: "By law, TRICARE pays after all other health insurance, except for: Medicaid." [16][17][18]
  - Ask the plan: Point32Health: whether Tufts Health Together also requires its own ABA PA when it is secondary. The claims chapter does not say.

## Delivery and billing rules

Coverage decides whether Tufts Health Together (Point32Health) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Daily limits / MUEs** _(ask the plan)_: Massachusetts is a no-cap state that nonetheless has one published per-day number. There are no annual, lifetime or unit-of-service ceilings on the EPSDT benefit, and 101 CMR 358.03 is a rate regulation, not a limit regulation — it fixes per-15-minute rates and states they are “full compensation” including “necessary administration and professional supervision associated with patient care.” The only per-day cap in the performance specification is for group instruction, which “may occur up to 4.5 hours a day as clinically indicated, in groups of 2-8 Members.” No per-code MUE regime is published, so what bites in practice is medical-necessity review and the supervision-ratio audit, not a unit edit. No Together-specific per-day edit is published. [7]
  - Ask the plan: Point32Health provider services.
- **Place of service** _(ask the plan)_: Home and community, with school carved out. ABA “is delivered by a contracted and credentialed provider in a variety of settings within a Member’s home and community,” and “services provided in a school setting are distinct and separate from those covered by the health plan and are typically covered by the educational system’s special education resources as part of the Individualized Education Program (IEP) pursuant to Public Law 94-142.” Providers “must not direct, limit, or discourage access to other medically necessary or school-based services.” Transition planning contemplates moving a member “from a center based setting to home/community settings,” so centers are in scope. Group homes are not addressed. No Together-specific deviation is published. [6]
  - Ask the plan: Point32Health provider services.

## What intake should collect for Tufts Health Together (Point32Health)

- **MCO vs. ACPP:** The Tufts Health Together MCO no longer exists (discontinued 1/1/2026) — confirm the family is on one of the two active ACPPs, not a stale MCO card.
- **The RIGHT form:** Tufts Health Together takes Point32Health's own ABA PA form — not the MA standard form. Flag it in your intake workflow.
- **ACPP mapping:** Cambridge Health Alliance and UMass Memorial ACPP members are Tufts Together — route to Point32, not Carelon.
- **Diagnostic evaluation:** ASD assessment — or the Down syndrome pathway from 1/1/2026, which Point32 confirms includes this plan.
- **Accreditation status:** Point32's ABA accreditation requirement is a network gate — check where your organization stands before quoting start dates.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How Tufts Health Together (Point32Health) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (Availity):** 04298 — Sourced from the stale (2012) Availity payer list — downgraded to inferred pending reconfirmation. Note: Tufts/Point32Health's own 270-271 companion guide (May 2017) documents a SEPARATE, non-payer-ID identifier for real-time eligibility — CAQH CORE ReceiverID 170558746 — which is not interchangeable with the 04298 clearinghouse payer ID; confirm which your integration actually needs.
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** None — internal Point32Health UM (no external BH vendor)
- **BH administrator payer ID:** n/a
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required — via Point32Health's own updated ABA PA form and internal UM (not the Massachusetts Standard ABA PA form, not the Carelon/MBHP performance spec) | — | — | — | — |
| 97152 | Yes | Required — via Point32Health's own updated ABA PA form and internal UM (not the Massachusetts Standard ABA PA form, not the Carelon/MBHP performance spec) | — | — | — | — |
| 97153 | Yes | Required — via Point32Health's own updated ABA PA form and internal UM (not the Massachusetts Standard ABA PA form, not the Carelon/MBHP performance spec) | — | — | — | — |
| 97154 | Yes | Required — via Point32Health's own updated ABA PA form and internal UM (not the Massachusetts Standard ABA PA form, not the Carelon/MBHP performance spec) | — | — | — | — |
| 97155 | Yes | Required — via Point32Health's own updated ABA PA form and internal UM (not the Massachusetts Standard ABA PA form, not the Carelon/MBHP performance spec) | — | — | — | — |
| 97156 | Yes | Required — via Point32Health's own updated ABA PA form and internal UM (not the Massachusetts Standard ABA PA form, not the Carelon/MBHP performance spec) | — | — | — | — |
| 97157 | Yes | Required — via Point32Health's own updated ABA PA form and internal UM (not the Massachusetts Standard ABA PA form, not the Carelon/MBHP performance spec) | — | — | — | — |
| 97158 | Yes | Required — via Point32Health's own updated ABA PA form and internal UM (not the Massachusetts Standard ABA PA form, not the Carelon/MBHP performance spec) | — | — | — | — |
| 0362T | Yes | Required — via Point32Health's own updated ABA PA form and internal UM (not the Massachusetts Standard ABA PA form, not the Carelon/MBHP performance spec) | — | — | — | — |
| 0373T | Yes | Required — via Point32Health's own updated ABA PA form and internal UM (not the Massachusetts Standard ABA PA form, not the Carelon/MBHP performance spec) | — | — | — | — |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Point32Health self-manages ABA UM against its own medical-necessity guideline (InterQual + SmartSheets, new MNG eff. 1/1/2026) rather than the state-baseline Carelon/MBHP mechanics used by every other MassHealth administrator — no code-level unit-cap/POS/modifier detail was retrieved from Point32's own MNG or ABA PA form this pass. Verify via: Point32Health provider services, or the Tufts Health Together ABA Medical Necessity Guideline PDF (point32health.org).

### Contacts

- **Provider services phone:** 1-888-257-1985
- **Hours:** Monday-Friday, 8:00 a.m.-5:00 p.m. (Tufts Health Direct, Tufts Health RITogether, Tufts Health One Care, and Tufts Health Together - MassHealth MCO Plan and Accountable Care Partnership Plans, per Point32Health's own contact-us page)
- **Portal:** [Tufts Health Plan Provider Portal](https://providers.tufts-health.com/thp/portal/providers/login/)

Questions to ask on a verification call:

- What is Tufts Health Together's pVerify payer ID for real-time eligibility checks?
- Does Tufts Health Together support standard clearinghouse real-time 270/271, or only the CAQH CORE connection described in its 2017 companion guide?
- What are the per-code daily/weekly unit caps for ABA codes 97151-97158/0362T/0373T under Tufts's own InterQual-based medical necessity guideline?
- What POS codes and telehealth billing modifiers does Tufts require for ABA?

### VOB data sources

- https://pverify.com/payer-list/ (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.point32health.org/documents/thpp-270-271 (accessed 2026-07-23; source document older than 18 months)
- https://www.mass.gov/doc/masshealth-standard-companion-guide-health-care-eligibilitybenefit-inquiry-and-information-response-270271-0/download (accessed 2026-07-23; source document older than 18 months)
- https://www.point32health.org/provider/contact-us (accessed 2026-07-23)

## Common questions

### Is the Tufts Health Together MCO still active?

No — MassHealth discontinued the Tufts Health Together MCO product effective January 1, 2026 (All Provider Bulletin 410). Only the two ACPPs, with Cambridge Health Alliance and with UMass Memorial Health, remain active.

### Does Tufts Health Together cover ABA?

Yes, through its two active ACPPs — the MassHealth EPSDT benefit with no published hour caps, reviewed by Point32Health's internal UM against its own medical-necessity guideline (InterQual + SmartSheets; new MNG effective 1/1/2026).

### Does Tufts Health Together use the Massachusetts standard ABA form?

No — as of the October 2025 update, members use Point32Health's own updated ABA PA form, submitted electronically with the form uploaded or faxed to 888-977-0776. It's the one MassHealth plan family where the standard form doesn't apply.

### What is Point32Health's ABA accreditation requirement?

A rolling network-participation requirement that ABA providers hold accreditation from a nationally recognized ABA accrediting body, across Harvard Pilgrim and Tufts Health Plan products — treat it as a contracting prerequisite.

## Primary sources

1. [MassHealth — All Provider Bulletin 410: Changes to MassHealth's ACOs on January 1, 2026](https://www.mass.gov/doc/all-provider-bulletin-410-changes-to-masshealths-accountable-care-organizations-on-january-1-2026/download)
2. [Point32Health — Reminder: Tufts Health Together MCO discontinuing as of Jan. 1](https://www.point32health.org/provider/reminder-tufts-health-together-mco-discontinuing-jan-1-112025)
3. [Point32Health — ABA policy and coverage updates (Oct 2025)](https://www.point32health.org/provider/applied-behavioral-analysis-policy-and-coverage-updates-102025)
4. [Tufts Health Together ABA Medical Necessity Guideline (PDF)](https://www.point32health.org/provider/wp-content/uploads/sites/2/2024/11/ABA-THP-Together.MNG_.pdf)
5. [MassHealth Managed Care Options — plan/BH-vendor map (April 2023)](https://abh.memberclicks.net/assets/docs/KeepingCoverage/2023%20MassHealth%20Accountable%20and%20Managed%20Care%20Options%20031723.pdf)
6. [Carelon/MBHP Performance Specifications — Applied Behavior Analysis (upd. Feb 15, 2026)](https://providers.masspartnership.com/pdf/PerfSpec-ABA.pdf)
7. [101 CMR 358.03 Rate Provisions (Cornell LII mirror)](https://www.law.cornell.edu/regulations/massachusetts/101-CMR-358-03)
8. [MassHealth ABA supervision audit & recoupment (Acuity News)](https://acuity.news/regulation/masshealth-aba-supervision-audit-recoupment-litigation-2026/)
9. [AIRC — MassHealth ABA Coverage factsheet](https://massairc.org/factsheets/masshealth-aba-coverage/)
10. [MA Standard ABA PA Form (MassHealth version, upd. 3/12/2026)](https://www.wellsense.org/hubfs/Forms/Provider_Forms/Applied_Behavioral_Analysis_Prior_Authorization_Form_MassHealth.pdf)
11. [Tufts Health Public Plans Provider Manual — Utilization Management chapter (2026, rev. 4/7/2026)](https://www.point32health.org/documents/thpp-06-um-pm)
12. [Tufts Health Public Plans Provider Manual — Referrals, Prior Authorization and Notifications chapter (2026)](https://www.point32health.org/documents/thpp-04-referrals-pa-notification-pm)
13. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-438.210)
14. [WellSense — Reduction of prior authorization decision timeframes (provider communication, Oct 31 2025)](https://www.wellsense.org/hubfs/Provider/News/WellSense_Mass_Provider_Communications_PA_Updates_10_31_25.pdf)
15. [Carelon Behavioral Health — Massachusetts Addendum (114_0526 rev.)](https://www.carelonbehavioralhealth.com/content/dam/digital/carelon/cbh-assets/documents/ma/massachusetts-provider-addendum.pdf)
16. [Tufts Health Public Plans Provider Manual — Claim Requirements, Coordination of Benefits and Dispute Guidelines (2026)](https://www.point32health.org/documents/thpp05claimspm)
17. [130 CMR 450.316 — MassHealth third-party liability: requirements (Cornell LII mirror)](https://www.law.cornell.edu/regulations/massachusetts/130-CMR-450-316)
18. [TRICARE — Using Other Health Insurance](https://tricare.mil/Plans/OHI)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.