US Family Health Plan of Southern New England is a TRICARE Prime option, funded by the Department of Defense.
US Family Health Plan provides the full TRICARE Prime benefit, including doctor visits, hospitalizations, emergency care, and prescription medications to nearly 15,000 members in southern New England. Tufts Health Plan, our third-party administrator, provides claims processing, referral management, and member-relations services.
The Plan is available to families of active-duty service members and to retired service members and their families.
As of December 3, 2021, Massachusetts has deployed three free mobile clinics (Fall River, Holyoke, and Everett) providing monoclonal antibody treatment for high-risk individuals who have been exposed to or who have COVID-19. These therapies have been shown to be effective in reducing the severity of the disease and in keeping COVID-19-positive individuals from being hospitalized. Referral from a health care provider is required. The mobile units can be relocated easily based on demand.
More information for providers is available at Mass.gov.
May 2020. Because of the COVID-19 pandemic, we’ve been receiving questions about Telehealth/Telemedicine services and how they should be billed with US Family Health Plan.
Please note that we are accepting GQ, GT, and 95 modifiers.
We now also provide codes for coverage of audio-only telephonic office visits by our network providers: (1) Evaluation and management visits represented by CPT 99441-3; 98966-8; HCPCS G2012; (2) other services such as psychotherapy when reported by the appropriate CPT and/or HCPS codes, and other appropriate coding such as place of service or modifiers; and (3) subsequent, new, or re-numbered codes as appropriate for medically or psychologically necessary care and treatment eligible for reimbursement and cost-sharing.
Administrative services (for example, making appointments or verifying prescriptions) are not separately reimbursed services.
These measures are effective as of May 12, 2020 and expire upon the expiration of the President’s national emergency for the COVID-19 outbreak.
If you have any questions, please call us at 1.800.818.8589.
Lead Provider Relations and Sales Analyst
A native of Hopkinton, Massachusetts, Tom He runs has an interest in healthy cooking, especially sous-vide cooking. Tom and Bark Lee, an American yellow Lab, live in Allston. Tom has worked with US Family Health Plan since 2011.