Frequently Asked Questions
My office participates with TRICARE—do we automatically participate with US Family Health Plan as well?
No. US Family Health Plan is part of the military health system but is administered locally and separately from the regional TRICARE contractor. If you are interested in participating, please contact Billy Partain, Senior Provider Network Coordinator, at Billy.Partain@usfamilyhealth.org.
Are you part of Tufts Health Plan?
No, US Family Health Plan is contracted with Tufts Health Plan to serve as our third party administrator. Tufts Health Plan supports US Family Health Plan by handling the claims, referral and case management, as well as our customer service line.
We billed Medicare by mistake: what should we do?
US Family Health Plan cannot pay any claim that has first been billed to Medicare. You must first reimburse Medicare for any payment made and then bill US Family Health Plan.
Is there a time limit for claims submission?
Submit all claims within a 90‐day time frame. This must coincide with the date of service, date of discharge or date of primary carrier’s Explanation of Benefits (EOB). Claims received after this time frame will be denied, and the member will not be held responsible for payment.
When are referrals required?
Referrals are required for most specialty care, including physical therapy, ophthalmology services and services within your network referral circle. Referrals are also required for GYN services, excluding the patient’s yearly exam. Referrals are not required for lab services, radiological services, outpatient mental health and obstetric services within your IPA.
Can we submit referrals online?
Yes, you may submit in-network referrals online; the same way you do for your Tufts patients. However, out-of-network referrals must be done on US Family Health Plan paper referral forms.
How do we obtain paper referral forms?
E-mail orders to email@example.com, or fax to 1-800-738-3272. The form name is REF-USFHP.
Which hospitals are contracting facilities?
For the most current list of network hospitals, please refer to the Provider Network section of this site.
If we treat someone who’s a member of one of the other US Family Health Plans, where do we send the paperwork?
All US Family Health Plan member ID cards indicate which plan the member belongs to. Please send the claim to the appropriate US Family Health Plan so it can be paid. For details, visit our national site: usfhp.org.
If one of our PCPs opens/closes a panel, can we just tell Tufts?
No, you must notify our provider coordinator of all changes and updates, including a panel change, change of address, phone number, or if a new provider needs to be added.