Referrals to In-Network Specialists

To see a specialist in the US Family Health Plan network (which is not identical to the Tufts Health Plan network), a member needs a referral from his or her primary care provider (PCP). Find out whether a specialist is in our network on our provider search site or by calling Provider Services at 1.800.818.8589.

In some instances, Plan authorization is also required. Referrals ordinarily last for one year or the number of visits indicated, whichever comes first.

Please submit the US Family Health Plan referral form one of these ways:

• Electronically, using Tufts Health Plan’s secure website, NEHEN, NEHENNet, or EmdeonTM
• Or by mailing to PO Box 495, Canton, MA 02021-0495

If Plan authorization is needed, submit the referral form and documentation one of these ways:

• Electronically, using Tufts Health Plan’s secure website, NEHEN, NEHENNet, or Emdeon™. Always accompany by fax/e-fax transmittal of documentation and clinical notes with member ID and referral number. Out-of-network referrals will be denied unless accompanied by this information.
• Fax/e-fax the referral form to, including documentation and clinical notes.
• Or mail to US Family Health Plan, Care Coordinator, 77 Warren Street, Boston, MA 02135, including documentation and clinical notes.

Our Care Coordinator responds in 2 to 3 business days.

Referrals to Out-of-Network Specialists

To see a specialist not in the US Family Health Plan network, a member needs a referral from his or her PCP and authorization from US Family Health Plan. If a member is seen by an out-of-network specialist without a referral and Plan authorization, or with a referral but without Plan authorization, the member must pay significant out-of-pocket costs under the Plan’s point-of-service policy.

Referrals are not required for visits to in-network mental health providers, chiropractors, or optometrists. However, the number of visits in a calendar year are limited.

In the “Diagnosis/Reason for Referral” section of our referral form, explain why you are referring the member to a specialist not in our network, and submit documentation, including clinical notes, to support your request.

For out-of-network authorization, submit the referral form and documentation one of these ways:

• Electronically using Tufts Health Plan’s secure website, NEHEN, NEHENNet, or Emdeon™. Always accompany by fax/e-fax transmittal of documentation and clinical notes with member ID and referral number. Out-of-network referrals will be denied unless accompanied by this information.
• Fax/e-fax the referral form to 855.270.5470, including documentation and clinical notes.
• Or by mailing to US Family Health Plan, Care Coordinator, 77 Warren Street, Boston, MA 02135, including documentation and clinical notes.

Our Care Coordinator responds in 2 to 3 business days.