Case Management Lists

Tufts Health Plan Medicare Preferred Case Management
Please access the Tufts Medicare Preferred Case Management List to identify the appropriate Tufts Medicare Preferred Case Manager assigned to both inpatient acute or extended care admissions.  The list is sorted by the medical group number.  Bolded entries signify that the case manager (CM) is affiliated with a delegated group (DCM).  Unless otherwise specified, each case manager is responsible for handling both inpatient acute (AC) or extended care (EC) admissions.

Please note that Tufts Health Plan Medicare Preferred Case Managers will continue to submit Requests for Information (RFIs) to acute inpatient and extended care facilities to obtain clinical information to support continued stay.

Tufts Health Plan Commercial Case Management

Overview
When a Tufts Health Plan commercial member is admitted to a hospital, a case manager (CM) or delegated case manager (DCM) needs to be contacted for care management and authorized reviews. To help with locating the appropriate CM or the DCM, Tufts Health Plan has created the lists below.

Acute Care Hospital Providers
The following member information is needed in order to determine whether a provider needs to contact a commercial Tufts Health Plan CM or DCM:

• the member's product type (e.g., HMO, POS, PPO)
• the member's Provider Unit number (e.g., 01, U1)

The Commercial Case Management List is organized alphabetically by hospital name.

All Select Network members are managed by the Tufts Health Plan Case Manager, Linda Henry, (888) 880-8699 ext. 4185.

If your hospital is the primary admitting hospital for a delegate, identify the DCM and corresponding phone number by referring to the member's Provider Unit number and the member's product.

At some hospitals, there is a second delegate who is responsible for all Tufts Health Plan members, except PPO members, admitted to their home hospital. The contact information for this delegate is found in a Note. For example, within the Addison Gilbert row, the following note appears;

Note: For those HMO, POS & EPO members that do not belong to PU29, contact the Northeast Triage line at (978) 236-1772

Each network hospital has an assigned Tufts Health Plan Case Manager. The Tufts Health Plan Case Managers assignment ranges from a minimum of all PPO products to PPO products plus additional HMO, POS and EPO products.

Acute Rehabilitation Hospital, Long Term Acute Care Facilities, Skilled Nursing Facilities, Hospice and Home Care Providers
For HMO members assigned to any of the following Provider Units access the Commercial Delegated Case Manager Assignment List to find the DCM responsible for care management and authorization reviews:

02;04;05;10;14;17;29;48;52;55;64;AT;AV;BS;CB;P2;P3;P6;P7;P8;P9;Q0;Q1;Q2;Q3;R0;R1;R2;R3;R4;R5;R6;R7;R8;R9;S0;S1;
S2;S3;S4;S8;T0.

Extended Care Providers:
In the applicable list for the level of care, locate your facility's name to find the case manager assigned to your facility:
Acute Rehab
Long Term Acute Care
Skilled Nursing Facility
Transitional Care Unit

Home Care and Hospice Providers:
In the applicable list for the level of care, locate your facility's name to find the case manager assigned to your facility:
Home Care
Hospice