Tufts Health Plan 60-Day Notification
Effective December 1, 2009
Updated Effective Date for Speech Therapy Coverage Changes

Note: The following change was originally announced in the August 1, 2009, issue of Provider Update as effective October 1, 2009. It was delayed as of October 9, 2009, and will now be implemented on December 1, 2009.

Tufts Health Plan has updated the diagnosis codes listed in the Medical Necessity Guidelines for Speech Therapy to align with current correct coding guidelines as published in the ICD-9 manual.

Effective December 1, 2009, claims for speech therapy submitted with a diagnosis code listed in Attachment A will deny. The member will be responsible for payment for those services, as stated in the member’s handbook.

Contracting providers should note that members can be held liable for non-covered services only if the member agreed to pay for those services after being informed the services are non-covered and signs a valid waiver of liability. The waiver must clearly demonstrate that the member agreed in advance in writing to pay for those services after being so informed. A general statement agreeing to pay for services not paid by the insurer is not sufficient.

For more information, refer to the Medical Necessity Guidelines for Speech Therapy.

August 1, 2009
Updated November 11, 2009
Note: The information in this article was correct as of the date of posting and may not reflect subsequent policy changes.