Tufts Health Plan
Also covers / subsidiaries: THP, Point32Health, Tufts Medicare Preferred
Core Payer & Clearinghouse Profile
Electronic Payer ID
04298
Used for professional, institutional, secondary, and ERA; legacy Stride Medicare ID 04245 is being phased out. Match to the member's product.
Timely Filing Limit (TFL)
90 calendar days for Tufts Health Public Plans; commercial line varies — verify in the commercial provider manual
Appeal Window
Varies — confirm via portal / clearinghouse
Clearinghouse Gateway
Clearinghouses and direct EDI
Provider Services
888-257-1985
Claims Fax
Varies — confirm via portal / clearinghouse
Claims Address
Varies — confirm via portal / clearinghouse
Provider Portal
https://tuftshealthplan.com/provider/home
Massachusetts plan now under Point32Health (Tufts + Harvard Pilgrim merger). Multiple product lines with different rules — match the member's product.
National EDI Clearinghouse Capabilities
Direct ANSI X12 electronic transaction support verified for Tufts Health Plan.
Associated Clearinghouse Payer IDs
National clearinghouse networks maintain dedicated routing IDs for specific transaction lines or subsidiaries under Tufts Health Plan.
| Clearinghouse Name | Electronic Payer ID | Status | Enrollment | Supported Services |
|---|---|---|---|---|
| Point32 Health | P3201 | Par | None | 835 ERADental |
| Tufts | 04298 | Par | None | 837P837I270/271Dental |
| Tufts Health Plan | 04298 | Non-Par | Required | 837P837I835 ERA |
Resolution Tools for Tufts Health Plan Claims
Values vary by plan, line of business, and provider agreement. Confirm in the payer portal or with your clearinghouse gateway before submitting electronic claims.
Tired of Chasing Tufts Health Plan Denials & Delayed Payments?
Aethera's billing specialists work Tufts Health Plan every day — handling EDI clearinghouse rejects, prior authorizations, payment posting, and 30-day AR aging recovery.