TAILIEUCHUNG - Obstetrics/Gynecology Professional Payment Policy

Earlier this year, the Texas Health and Human Services Commission reported to its state legislature that WHP has been effective in reducing unplanned births and has saved the state millions of dollars due to the reduction in Medicaid costs associated with those births. It estimated that over 8,000 births were averted in 2011, yielding $54 million in net savings (federal plus state), including more than $23 million in state savings. We estimate that, if Planned Parenthood affiliates had been excluded in 2011, the resulting reduction in family planning services would mean that 2,000 to 3,000 fewer. | Obstetrics Gynecology Professional Payment Policy TUFTS ir Health Plan provlders Provider Services - 888-884-2404 The following payment policy applies to Tufts Health Plan commercial contracted providers who render obstetrical and or gynecological services. This policy applies to commercial1 products. Note Audit and disclaimer information is located at the end of this document. Policy Tufts Health Plan covers medically necessary obstetrical and gynecological services as described below. General Benefit Information2 Services and subsequent payment are based on the member s benefit plan document. Providers and their office staff are required to use self-service channels to verify effective dates and copayments for commercial members prior to initiating services. Refer to the Electronic Services section of our website for our self-service channel options. Benefit specifics should be verified prior to initiating services by logging on to our website or by contacting Provider Services. Nuchal Translucency Testing Tufts Health Plan covers the Nuchal Translucency test based upon the member s medical risk factor and medical necessity as determined by the Obstetrician Gynecologist. This test does not require prior authorization. Nuchal Translucency testing is done by ultrasound. In combination with the testing of maternal blood for free B-hCG and pregnancy associated plasma protein-A a determination of the risk of Down syndrome can be made. This testing is also known as Early Risk Assessment ERA Ultrascreen Firstlook or First trimester screening. Gynecology Tufts Health Plan members are covered for one routine gynecology visit per calendar year any medically necessary gynecological follow-up care identified at the examination and any additional medically necessary gynecological conditions. Family planning services including birth control counseling and contraceptive management genetic counseling and termination of pregnancy are not part of the .

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