Commercial Provider Manual Updated

Tufts Health Plan reviews and revises its Commercial Provider Manual at regular intervals throughout the year. Please be sure you are familiar with information in the manual, including the following:

• A description of Tufts Health Plan’s utilization management (UM) program
• How to obtain Tufts Health Plan’s Medical Necessity Guidelines (UM criteria)
• How to discuss UM decisions with reviewers
• Tufts Health Plan’s criteria for medical record-keeping documentation
• Plan members’ rights and responsibilities
• A link to the recent Clinical Practice Guidelines for treating substance abuse
• Tufts Health Plan’s policy on financial incentives for UM decision-makers

It is the responsibility of the attending physician to make all clinical decisions regarding medical treatment. Network physicians may obtain these guidelines in the Clinical Resources section of tuftshealthplan.com/providers.

November 1, 2009