Tufts Health Plan

Summary

Tufts Health Plan is a regional health plan, part of Point32Health, offering dental, medical, and vision coverage operating in 4 states. Claims route under payer ID 04332, with 2 alternate IDs in use across clearinghouses. Provider enrollment typically takes 60-90 days, with applications through Point32Health Provider Portal, and CAQH is used for credentialing data. Through clearinghouses it supports eligibility checks, claim status inquiries, professional claims, institutional claims, and electronic remittance (ERA); ERA enrollment is required and takes several weeks.

At a glance

Payer ID

04332Also seen as 2523, 5475

Also known as

Network Health, Point32Health

Uses CAQH

YesApplication route: CAQH application only

Service area

MA, NH, RI, CT

Clearinghouse transaction setup

Which EDI transactions this payer supports, and how long clearinghouse enrollment typically takes when it is required.

Common questions

What is the payer ID for Tufts Health Plan?

The payer ID for Tufts Health Plan is 04332. Alternate IDs seen across clearinghouses include 2523, 5475.

How long does Tufts Health Plan provider enrollment take?

Tufts Health Plan provider enrollment typically takes 60-90 days from application to effective date. Timelines vary by state, plan, and how complete the application is.

Does Tufts Health Plan require CAQH?

Yes. Tufts Health Plan uses CAQH for credentialing data, so keep the provider's CAQH profile current and attested before applying.

Does Tufts Health Plan require ERA enrollment?

Yes. Tufts Health Plan requires a separate ERA (835) enrollment before electronic remittances flow, and setup typically takes several weeks.

What states does Tufts Health Plan cover?

Tufts Health Plan operates in MA, NH, RI, CT. Coverage can differ by plan and product line, so confirm the specific plan before you file.

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