Fallon health provider phone number Providers interested in joining the Beacon network can contact the dedicated number for Beacon/Fallon at 1-888-421-8861. Care Connect gives you 24/7 phone access to registered nurses Once you are logged into the Fallon Health site, all information transferred is sent using SSL. | Back to top | Question: When verifying my patient's eligibility, I noticed that my phone number is incorrect. Home | About | Careers | News Room | Contact Us; 1-855-665-1112 (TTY 711) Doing Business with Fallon Health Weinberg . I will notify Fallon Health immediately by calling 1-866-275-3247, option 6, This form replaces Fallon's Provider Claims Adjustment Request Form and the Provider Appeals Request Form. 1 Fallon Medicare Plus Home phone number () - Fallon Health - CY 2024 Medicare Star Ratings (H8928_240222_M, pdf) Fallon Health - CY 2025 Medicare Star Ratings (coming soon, pdf) Notice of availability of language assistance services and auxiliary aids and services (H8928_240600_C, pdf) Phone. Behavioral health (mental health and substance use disorder) resources Fallon Health's behavioral health partner, Carelon Behavioral Health, has information and resources to help you. More Fallon Health will mail an attestation form to employers whose Fallon Health plan does not meet minimum creditable coverage standards. What you should know about CAHPS and HOS Fallon Health is committed to partnering with our providers to deliver the best possible experience for your Fallon Health Weinberg-MLTC The Fallon Health Weinberg-MLTC plan has closed. All elective inpatient admissions must be authorized by Fallon Health’s Prior Authorization (PA) Department prior to admission. wellforce. Electronic data submission and Provider Tools inquiries. If you need help finding a health care provider, or if you would like to ask for information about a health care provider’s race or ethnicity, please contact us at 1-855-203-4660 (TRS 711), Monday - Friday, 8 a. Get Adobe Reader (This link takes you away from the Fallon Health Weinberg website. Optum Prior Fallon Health offers Electronic Funds Transfer (EFT) and the 835 Health Care Claim Payment/Advice through PaySpan. Fax number: Please enter the fax number in the following format: 123-123-1234. Fallon Medicare Plus Provider Directory (pdf, last updated 12/17/2024) Fallon Medicare Plus Central Provider Directory (pdf, last updated 12/17/2024) Or: Find a behavioral health provider. Call 1-800-845-6592 or you can also register for Fallon Health’s provider tools, Sometimes it’s hard to reach your own doctor when you need care for a non-urgent problem. Home | About | Careers | News Room | Contact Us; 1-855-665-1112 (TTY 711) 8:30 a. . Carelon Behavioral Health is Fallon's behavioral health partner. $0 adult day health. As a Fallon Health member, you have another option—Care Connect. When you join Fallon Health, The first time you log in, you’ll need to enter your member ID number. If you would like secure access to Fallon Health’s Provider Tools, please have your office manager fill out the form below. Call our Compliance Hotline to report any concerns you may have regarding compliance, fraud, waste or abuse. org Do you want more information about Wellforce Care Plan providers? Fallon Health phone and fax numbers Provider Phone Number: 1-866-275-3247 Care Review Fax: 1-508-368-9700 Care Review Urgent Fax: 1-508-368-9133 Inpatient Care Services Fax: 1-508-368-9175 *Participants of the collaborative include: Fallon Health phone and fax numbers Provider Phone Number: 1-866-275-3247 Care Review Fax: 1-508-368-9700 Care Review Urgent Fax: 1-508-368-9133 Inpatient Care Services Fax: 1-508-368-9175 *Participants of the collaborative include: Our phone number is 1-877-700-6996 (TRS 711), 8 a. For FHW direct claims submitters . Fallon Medicare Plus Provider Directory (pdf, last updated 12/17/2024) Fallon Medicare Plus Central Provider Directory (pdf, last updated 12/17/2024) Or: any provider who accepts Medicare and you as a patient. We offer a choice of doctors—so you can easily find a doctor who speaks your language or Frequently asked questions about Fallon Community Health Plan for FCHP members. We deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and Berkshire Fallon Health Collaborative 1-855-203-4660 (TRS 711) Monday through Friday, 8 a. Call us toll-free at 1-888-340-5504 (TRS 711), 8 a. Your Provider Filter is in the upper right-hand corner of your screen. If you have a username and password that you use to get into Fallon Health's Document Center or Preference Portal, you'll use that same username and password to log into MyFallon. Skip to Main Content | FCHP Homepage | Accessibility Statement. Behavioral health questions. This portion of the website is temporarily undergoing maintenance. Commercial plans. Learn more Provider and Pharmacy Directory. If you would like a Provider and Pharmacy Directory mailed to you, please complete our online form. To make things a little easier, we’ve also included the address and phone number for each office location. Our health insurance plans and programs are designed with you in mind, providing coordinated care and supportive services that help you live better. Fallon Health is an HMO plan with a Medicare contract. Free rides to and from medical appointments When enrolling a new provider with Fallon Health, please provide the Medicare Provider Number (MPN) and the MassHealth Provider ID Service Location (PIDSL) as applicable. We're doing some housekeeping. Contact us by phone. Provider office information Contact name (Person completing this form) Today’s date (MM/DD/YYYY) Practice phone number Practice email address Provider/facility name If you need help finding a health care provider, or if you would like to ask for information about a health care provider's race or ethnicity: Fallon Medicare Plus members and prospects, please call 1-800-325-5669 (TRS 711), Monday - Friday, 8 a. Fallon Medicare Plus Provider Directory (pdf, last updated 12/17/2024) Fallon Medicare Plus Central Provider Directory (pdf, last updated 12/17/2024) Or: Fallon Health's Provider Relations Department produces this manual for participating physicians, hospitals, ancillary providers and their support teams. Box 2975 Mission, KS 66201 Fax (for prescription submissions only – no PAs): 1-877-342-4596 Prior authorization requests Please be mindful of Fallon Health provider payment policy changes highlighted in this and future Whether you're choosing a Medicare Advantage plan for the first time, thinking about changing to Fallon Medicare Plus, or would like to talk to us about our plan options, we're here to help. The Provider individual NPI number (Type 1 NPI): Pay-to NPI number (Type 2 NPI): Name of healthcare organization, physician organization or group provider is affiliated with: Fallon Health's Provider Relations Department produces this manual for participating physicians, hospitals, ancillary providers and their support teams. Revised December 2023 Fallon Health Provider Manual | 9 Admitting for Inpatient Stay A Fallon Health utilization management (UM) nurse will perform clinical reviews for level of care on all inpatient admissions. Learn more Look-up tools. If you don’t have a username and password to that you use to get into Fallon Health's Document Center or Preference Portal, you can register to use MyFallon. Fallon Health Welcome to Fallon Health! We’re glad you’re here. If you don’t know your member ID number, you can call Fallon Customer Service at 1-800-868-5200. The name, phone number, and address of the member's doctor or nurse. We work together to meet your health care needs. Developed in partnership with Fallon Health phone and fax numbers Provider Phone Number: 1-8 66-275-3247. Fallon Health-Atrius Health Care Collaborative is a MassHealth Accountable Care Organization (ACO) Partnership Plan. , Eastern time. m. To find out more information please go to the Provider Manual or contact Fallon's Provider Relations Department at 1-866-275-3247, press 4. How can I update my information? Question: What are the system requirements to use Provider Tools? Answer: The requirements to use the various Provider Tools, including electronic submission are: About Fallon Health | Contact us; Search. 24-686-110 Rev. Care Review Urgent Fax: 1-508-368-9133. 2. Answer each of the questions by checking the appropriate box or filling in the space provided. –6 p. Are you a provider? Call: 1-866-275-3247 address concerns or questions that may impact their experience with a MassHealth health plan or their ability to access their health plan benefits and services. Fallon Health: Community Care ConnectorCare 3 Coverage for: Individual and Individual (DOL - OMB control number: 1210-0147/Expiration DATE: 5/31/2022) (HHS - OMB control number: 0938-1146/Expiration DATE: 10/31/2022) C154 Coverage Period: Beginning on or after If you visit a health care provider's office or clinic Primary care visit to If you would like secure access to Fallon Health’s Provider Tools, please have your office manager fill out the form below. Inpatient Care Services Fax: 1-508-36 8-9175 Please submit ALL Fallon PA paperwork to: authteamclinicalintegration@fallonhealth. Fallon Health Companion Guide 1 Health Care Claim Payment Advice . org • 1-800-868-5200 Page 1 Community Care Connector High Silver II Benefit Summary—Benefits effective January 1, 2025 _____ The Fallon Health difference With Community Care Connector High Silver II, you get: • A fitness reimbursement of up to $150 that can be used for gym memberships at the gym of Learn about Berkshire Fallon Health Collaborative (BFHC) BFHC is a MassHealth Accountable Care Organization (ACO) Partnership Plan. To expedite prior authorizations, the provider should have the following information: • Member name, date of birth and ID number • Health plan name (Fallon Health) • Member height and weight • Ordering provider name, tax ID number, address, and office telephone and fax numbers Fallon Medicare Plus 2025 Summary of Plan Benefits This is a summary of drug and health services covered by Fallon Medicare Plus Orange HMO, Fallon Medicare Plus Green HMO, and Fallon Medicare Plus Blue HMO for January 1, 2025–December 31, 2025. $0 prescriptions and certain over-the-counter items with a prescription. The name, phone number and address of your doctor or nurse 3. Or you can email us at cs@fallonhealth. When it says “plan” or “our plan,” it means Fallon Medicare Plus Orange HMO). Fallon 365 Care; Berkshire Fallon Health Collaborative; Fallon Health-Atrius Health Care Collaborative; 1-844-720-0033. ) Multi-language Interpreter Services (H2470_W_2017_18_r1 Accepted 081616, pdf) Notice of inclusion resources (pdf) Fallon Health Provider Phone Number: Modern Healthcare ,1994-10 Long-term Care Options United States. 400, Worcester, MA 01608, or send it by faxing 1-508-755 To expedite prior authorizations, the provider should have the following information: • Member name, date of birth and ID number • Health plan name (Fallon Health) • Member height and weight • Ordering provider name, tax ID number, address, and office telephone and fax numbers Partnership Plan. , Monday–Friday. Fallon Health Weinberg 7 CLAIMS GUIDELINES should be entered on the CMS 1500 or equivalent as evidence • Box 17 – enter referring provider/PCP‘s name • Box 17b – enter referring provider/PCP‘s NPI number . Carelon Behavioral Health provider website Contact us for more information Do you have questions about Wellforce Care Plan? Call: 1-855-508-4715 (TRS 711) 8 a. If you have questions concerning the recently issued guidance, you can contact Provider Relations at askfchp@fallonhealth. Fallon Health phone and fax numbers Provider Phone Number: 1-866-275-3247 Care Review Fax: 1-508-368-9700 Care Review Urgent Fax: 1-508-368-9133 Inpatient Care Services Fax: 1-508-368-9175 *Participants of the collaborative include: Fallon Health's Provider Relations Department produces this manual for participating physicians, hospitals, ancillary providers and their support teams. ô )±ß{? ÏôêÙ´Å#„¨ Ùy5a Xé”¶Ëšýžÿ,/Y QX%Zg¡f ˆìjvöe:ßxˆ ©m¬Ù Ñ çÊ +çÁÒHã‚ H¯aÉ½ Å ø·Éä‚Kg ,–˜Ølú ±n±¸y¦Ï=Éƒ‡%+®û‰)«fÚ$ƒn€ j ´ñ@#¼oµ H«ã V •[ªŠ”Ýœ¸Ò>~%t6ž F^Cí lu·TÎ w"à/a ?¹ The member's plan member ID number. Skip to Main Content Provider directory API - Practitioner; Provider directory API - Organization; Provider directory API - Location; Revised September 2024 Fallon Health Provider Manual | 5 Quantity and duration limits To further ensure patient safety, *Instructions for submitting a PA, as well as ePA, phone, and fax numbers is located on our website, fallonhealth. They are aware that they can reach out to her or her staff with any questions. to 6 p. If you don't wish to call (or you called and weren't satisfied), you can put your complaint in writing and send it to us at Fallon Health, Member Appeals and Grievances, 1 Mercantile St. xml ¢ ( ´•OOã0 Åï+ñ "_W‰Ë Z5åÀ²Ç ‰®öìÚ“ÖlüGö è·gœ´Q© î. Any actions against a practitioner’s DEA, including but not limited Find health resources and tools to keep Fallon Health members well, learn about your health insurance benefits and coverage, and access your account information through MyFallon. If you are a former member and need a copy of your medical records, please call us at 1-866-882-8185 or 1-716-250-3100 (TTY 711), 8 a. Enter the full 13-digit identification number or enter the first 11 digits and the member’s date of birth. Find a behavioral health provider. • fallonhealth. • Practice address addition or change, to include phone and fax number Revised January 2024 Fallon Health Provider Manual | 8 Closing/reopening panels or practices to Fallon Health members A primary care provider (PCP) or an ob/gyn provider agrees to give the plan 30 days Fallon Health MassHealth ACO plan pharmacy coverage changes for 2025 – anti-obesity drugs These changes apply to our MassHealth ACO plans— Berkshire Fallon Health Collaborative, Fallon 365 Care, and Fallon Health-Atrius Health Care Collaborative: • Zepbound will be the only covered anti-obesity GLP-1*. Find psychiatrists, psychologists, social workers, mental health facilities and more. The information for my practice on Fallon Health Weinberg's provider directory IS NOT accurate as of today's date. Fallon Health offers Electronic Funds Transfer (EFT) and the 835 Health Care Claim Payment/Advice through PaySpan. Fax. to 5 p. $0 doctor visits and screenings. Subcommittee on Health,1997 The National Directory of Managed Care Organizations Managed Care Information ID cards left at home will no longer be a problem. You can also call Carelon Behavioral Health at 1-888-877-7184. Specialty 2. If you need help finding a health care provider, or if you would like to ask for information about a health care provider's race or ethnicity: Fallon Medicare Plus members and prospects, please call 1-800-325-5669 (TRS 711), Monday - Friday, 8 a. Use our Find a Doctor tool to find a NaviCare provider Revised April 2024 Fallon Health Provider Manual | 1 Credentialing process Criteria Hearings and appeals Assessment of organizational providers Practitioner rights the practitioner must provide the name and DEA number of the practitioner who will prescribe for them. org, in the Physicians and providers section, under “Pharmacy. If you want more detailed information about a provider please call them directly. First name * Last name * Degree. Benefits, premiums, deductibles, and/or copayments/coinsurance may change on January 1, 2026. , and the majority of Berkshire County community physician practices. Committee on Ways and Means. To find a provider for routine appointments, They’ll give you names and phone numbers of behavioral health specialists in your area, If you have questions, call Fallon Health at the number on the back of your ID card, or Carelon Behavioral Health at 1-888-421-8861. Fallon Health is an HMO plan with a Medicare contract and a contract with the Massachusetts Medicaid program. n Introducing new plan designs as of April 1 Effective April 1, 2019, upon anniversary, Fallon Health will be introducing four new Direct Care and Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Fallon Medicare Plus Blue HMO a Medicare HMO . The online Provider Manual represents the most current version available. 00 10/24. - 8 p. For CMS 1500 paper submitters: • Box 17 – enter referring provider/PCP’s name • Box 17b – enter referring provider/PCP’s NPI number For Fallon Health direct claims submitters Frequently asked questions about Fallon Community Health Plan for FCHP members. You are sometimes told to skip over some questions in this survey. (April–September, Monday–Friday) Fallon Health follows a new-to-market medication evaluation policy and usage determination for medications newly approved by the FDA. Please enter the phone number in the following format: 123-123-1234. Fallon Health. This document gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2025. Box 211308 Eagan, MN 55121-2908 To mail premium payments, address to Do you have questions about Fallon Health-Atrius Health Care Collaborative? Call : 1-866-473-0471 (TRS 711) 8 a. All are health care leaders who have been caring for MassHealth members for decades Program Manager has been emailing regularly with our provider network. If you have questions or want to learn more about Fallon's mobile ID cards, please call your Provider Relations representative at 1-866-275-3247. If you don’t have a username and password to that you use to get into Fallon Health's Document Center or Preference Portal , you can register to use MyFallon . | Back to top | Since Fallon cannot require that the provider refer you to anyone outside their “circle” for services, Provider Tools for Fallon Health Weinberg providers to assist in caring for our members. With MassHealth Standard and Medicare alone. and Wednesday from 10 a. , Monday – Friday. Fallon Health, Inc. © Fallon Health offers Electronic Funds Transfer (EFT) and the 835 Health Care Claim Payment/Advice through PaySpan. Enter your ZIP code. O. You can take training at Fallon Health's online University. TDD/TTY access for those who are hearing impaired is 877-608-7677. We deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and Find a behavioral health provider. You will need to have on hand: a. Login is not required for these applications. Our phone number is 1-800-325-5669 you can call Member Appeals and Grievances at the telephone number listed below: Fallon Health Member Appeals and Grievances 1 If you would like secure access to Fallon Health’s Provider Tools, please have your office manager fill out the form below. Since 1977, Fallon Health has offered high-quality, low-cost health insurance to our families, friends and neighbors in Massachusetts. 400, Worcester, MA 01608, or send it by faxing 1-508-755 The member's plan member ID number. If you need help finding a health care provider, or if you would like to ask for information about a health care provider’s race or ethnicity, please contact us at 1-855-508-3390 (TRS 711), Monday - Friday, 8 a. Care Review Fax: 1-508-368-9700 . Feel free to reach out to her by phone at 1-508-368-9061 or email at kathleen. You can also call Carelon Behavioral Health at 1-888-877-7182. Members must choose a PCP from the Direct Care network . You can write, call, or email us at: Compliance Director Phone: 1-508-368-9988 (TRS 711) Information for providers about working with Fallon Health Weinberg. This directory provides a list of the NaviCare network plan providers, including physicians, specialists, hospitals, pharmacies, and other providers. If you need help finding a health care provider, or if you would like to ask for information about a health care provider’s race or ethnicity, please contact us at 1-855-508-4715 (TRS 711), Monday - Friday, 8 a. – 6 p. Fallon 365 Care 1-855-508-3390 (TRS 711) Provider Relations Department 1-866-275-3247 askfchp@fallonhealth. It’s made up of Atrius Health, Fallon Health and other select community providers. behavioral health needs, please schedule an appointment with your Primary Care Provider, or go to your nearest emergency care center. Benefits. Box 2975 Mission, KS 66201 Medicaid/MassHealth ACO . Mail. Get care online or by phone. Employers receiving the form are required to complete and mail it back to Fallon attesting to meeting minimum creditable coverage standards. –8 p. Members not only have the ability to download their cards to their phones, they can also access their dependents' cards. It’s made up of Berkshire Health Systems (BHS), Community Health Programs, several Berkshire County community physician groups and Fallon Health. Do you have questions about Fallon 365 Care? Call: 1-855-508-3390 (TRS 711) 8 a. through the Provider Service Line: 1-866-ASK-FCHP, prompt 4. Community Care; 1-844-720-0035. n • Phone number • Specialty • Hospital affiliations • Panel status • Languages spoken by you or your staff Get Adobe Reader (This link takes you away from the Fallon Health Weinberg website. Eastern time. You are required to provide NPI number to the clearinghouse. Fallon’s primary clearinghouse Note: Effective 4/29/2024, Fallon Health has re-established our connection with Change Healthcare system for our 837 Health Care Claim transactions. , Monday–Friday, Review the Provider Directory (or ask your doctor) to make sure the doctors you see now • Your permanent address and phone number Note: You must complete all items in Section 1. Fallon Health is a leading health care services company Should you need to access any other Fallon Health provider tools, please sign up separately online at fallonhealth. Individuals shopping for a plan may call: 1-888-340-5504 (TRS 711), 8 a. You can also contact the Fallon Health Provider Relations Department, 1-866-275-3247, press 4, for more information. Find a doctor, dentist, or other If you need help finding a health care provider, or if you would like to ask for information about a health care provider’s race or ethnicity, please contact us at 1-866-473-0471 (TRS 711), Monday - Friday, 8 a. Customer Service Department 1-800-868-5200 (TRS 711) Monday, Tuesday, Thursday, and Friday from 8 a. Fallon offers a full range of affordable Massachusetts health insurance plans with some of the lowest monthly costs available. –5 p. As a member of A fitness reimbursement of up to $150 that can Where can I find more information about Fallon Health's plans? When verifying my patient's eligibility, I noticed that my phone number is incorrect. | Back to top | Since Fallon cannot require that the provider refer you to anyone outside their “circle” for services, Find a behavioral health provider. Frequently asked questions about Fallon Community Health Plan for FCHP members. accessing Fallon Health’s Provider Tools. The specialist submits a claim to Fallon Health with evidence of a referral (the PCP’s NPI number) from the member’s PCP. Please keep it in a safe place. Members must recei Vendor contact name/title/phone number: Vendor contact email address: IT contact name/title/phone number: IT contact email address: Provider tools user authorization . Enrollment in Fallon Health partnerships and strengthening the provider experience at Fallon Health. . Fallon is committed to keeping information secure and If you need help finding a health care provider, or if you would like to ask for information about a health care provider's race or ethnicity: Fallon Medicare Plus members and prospects, please call 1-800-325-5669 (TRS 711), Monday - Friday, 8 a. Optum Prior Your Provider Filter is in the upper right-hand corner of your screen. Phone number Interpreter services Office hours The hospital(s) to which he or she can admit patients Areas of special experience, skills and training Partnership Plan. PK !• 3¯¼ Ï [Content_Types]. $0 lab tests and X-rays. $0 hearing tests and hearing aids. Get the online tools and resources you need to take Program Manager has been emailing regularly with our provider network. $0 in-home care. If there’s anything else you need to do, we‘ll let you know. Enter the phone number you'd like us to contact you at: Fallon Health phone and fax numbers Provider Phone Number: 1-866-275-3247 Care Review Fax: 1-508-368-9700 Care Review Urgent Fax: 1-508-368-9133 Inpatient Care Services Fax: 1-508-368-9175 *Participants of the collaborative include: Find a behavioral health provider. org Do you want more information about Wellforce? Website: www. ) Multi-language Interpreter Services (H2470_W_2017_18_r1 Accepted 081616, pdf) Notice of inclusion resources (pdf) This page allows you to Find a doctor, dentist, or other health care provider using many different criteria. EDI Coordinators (Electronic data Provider List Fallon Health Weinberg-MLTC is pleased to offer this listing of providers by type of service and then by provider name. Refers to the ASC X12N 835 Technical Report Type 3 Guide (Version 005010X221A1) Companion Guide Version Number: 1. Members of BFHC will have all their health care managed by their Berkshire Fallon Health Collaborative 1-855-203-4660 (TRS 711) Monday through Friday, 8 a. Choose “Massachusetts” as your state, and “Fallon Health” as your plan. Berkshire Fallon Health Collaborative MassHealth ACO Partnership Plan Phone number Interpreter services Office hours The hospital(s) to which he • Pages 1-1948 include an alphabetical listing of all BFHC contracted behavioral health providers. Provider look-up Search for providers (including contracted individual and ancillary providers) by provider name, city, type, and other criteria. You can call the Hotline 24 hours a day, If you need help finding a health care provider, or if you would like to ask for information about a health care provider's race or ethnicity: Fallon Medicare Plus members 1-855-508-4715 (TRS 711), 8 a. To contact them, visit the website below (use "Massachusetts" as the state and "Fallon Health" as the plan), or call them at 1-888-421-8861. org To mail payment for a claim, address to: Fallon Health P. Use our Find a Doctor tool to find a NaviCare provider Contact us for more information Do you have questions about Wellforce Care Plan? Call: 1-855-508-4715 (TRS 711) 8 a. , Ste. * Please enter any information updates below. o Loop 2310A Segment NM1 –enter the referring provider/PCP‘s name If you need help finding a health care provider, or if you would like to ask for information about a health care provider's race or ethnicity: Fallon Medicare Plus members and prospects, please call 1-800-325-5669 (TRS 711), Monday - Friday, 8 a. cs@fallonhealth. | Back to top | Since Fallon cannot require that the provider refer you to anyone outside their “circle” for services, H8928_250111_M The information on this page was last updated on 10/1/2024. , 7 days a week. Scan this code with your phone to download the app (for iOS and Android) Fallon Health partners with MedSolutions to provide authorization services for high You can submit your authorization requests to eviCore healthcare for outpatient diagnostic imaging procedures by phone at 1-888-693-3211 or by fax at 1-888-693-3210 What does the eviCore healthcare authorization number look like? It is an 8 Fallon Health phone and fax numbers Provider Phone Number: 1-866-275-3247 Care Review Fax: 1-508-368-9700 Care Review Urgent Fax: 1-508-368-9133 Inpatient Care Services Fax: 1-508-368-9175 *Participants of the collaborative include: Limited HMO provider network = high- performing network . Whether you’re enrolled in Medicare or Provider Relations Department . Email: cs@fallonhealth. If so, let us know right away by calling the phone number on the back of your Fallon member ID card, Monday, Tuesday, Thursday and Friday from 8 a. Inpatient Care Services Fax: If you have questions concerning the recently issued guidance, you can contact Provider Relations at askfchp@fallonhealth. It is a dynamic page that displays new content on the page through various controls like text and combo boxes. , Monday–Friday (7 days a week, October 1–March 31). Phone numbers have been provided. org Anonymous Compliance Hotline. A not-for-profit health care services organization that is both an insurer and provider of care, we also work closely with providers, community leaders, government organizations, and others to enhance care and services. About Fallon Health | Contact us; Search. Fallon Health is a leading health care services company MassHealth from Fallon Health serves all cities and towns in Worcester County plus parts of Franklin County, Hampden County, Middlesex County and Norfolk County. 1-866-275-3247 askfchp@fallonhealth. Fallon Health phone and fax numbers Provider Phone Number: 1-8 66-275-3247. Please fill out one screening form for each new member. 12% premium savings compared to Select Care . Fallon Health & Life Assurance Company, Inc. org. Your plan member ID number b. 4. This document is available for free in a different format, such as large print and audio. If your task is urgent, please contact our Customer Service Department at the number on the back of your member ID card. for: LEARN MORE; OUR PLANS; PROVIDERS; Phone: 1-855-427-4682 Address: OptumRx P. For CMS 1500 paper submitters: • Box 17 – enter referring provider/PCP’s name • Box 17b – enter referring provider/PCP’s NPI number For Fallon Health direct claims submitters Fallon Health MassHealth Provider Network Directory fallonhealth. Resources for providers Recent bulletins and memorandum regarding urgent care coverage. , is a wholly owned subsidiary of Fallon Community Health Plan. documentation (PRA form, health care proxy or verbal permission over the phone). to Provider networks: Your choice of networks depends on your employer’s selection(s), Affordable health insurance in Massachusetts Massachusetts health insurance from a trusted source. resources, please call us at the phone number on the back of your member ID card. To log on: Fallon Health offers Electronic Funds Transfer (EFT) and the 835 Health Care Claim Payment/Advice through PaySpan. August 2018 Resources for providers Recent bulletins and memorandum regarding urgent care coverage. Consistent with All Provider Bulletin 384, Fallon Health will continue to pause PCP referral requirements for our MassHealth ACO plans: Berkshire Fallon Health Collaborative, Fallon 365 Care, • Phone number • Fax number • Panel status Exceptions: Fallon's eligibility verification will identify the plan in which the member is enrolled. Our highly trained representatives are available weekdays from 8:30 a. With NaviCare. Congress. Provider relations, Resources for providers Recent bulletins and memorandum regarding urgent care coverage. That’s why we offer a range of options to support different lifestyles and budgets. House. Each provider entry includes the same information as listed above, Provider Tools for Fallon Health Weinberg providers to assist in caring for our members. org Provider individual NPI number (Type 1 NPI): Pay-to NPI number (Type 2 NPI): Name of healthcare organization, physician organization or group provider is affiliated with: Phone. bien@fallonhealth. If you believe Fallon or a provider has discriminated against you or didn’t provide these resources, please tell us. Get the online tools and resources you need to take care of your patients who are Fallon Health members. You don't need to fill out this form for your provider to make the calling us is the first step. Specialty 1. Opioid management program Our standard opioid management program is aligned with the "Guideline for Prescribing Opioids for Chronic Pain" issued by the Centers for Disease Control and Prevention (CDC) in March 2016. This is an important legal document. ” IV. No PCP. If you have any questions, you can call and speak to a Fallon Health representative at 1-800-325-5669 (TRS 711), 8 a. Health Care Payment Advice. Fallon Health will mail an attestation form to employers whose Fallon Health plan does not meet minimum creditable coverage standards. org or contact your Provider Relations Representative. $0 hospital stays and services. org • 1-800-868-5200 Page 1 Community Care ConnectorCare 3 Benefit Summary—Benefits effective January 1, 2025 _____ The Fallon Health difference With Community Care ConnectorCare 3, you get: • arrange most of your care. Community Health Programs, Inc. Its mission is, Improving health and inspiring hope. for: LEARN MORE; OUR PLANS; PROVIDERS; Provider and Pharmacy Directory. EDI Coordinators 1-866-275-3247, Option 6 Verify or update your practice information; Join our network. You can also call Carelon Behavioral Health at 1-888-777-1207. Survey instructions: 1. It’s made up of Fallon Health—the health plan, and Atrius Health—the medical provider. No referrals. Fallon will then send 1099-HC forms to employees by January 31, 2025. To learn more, click the link below, then choose “Massachusetts” as your state and “Fallon Health” as your plan. - 6 p. org Do you want more information about Wellforce Care Plan providers? At Fallon Health, our goal is to make sure you get the care you need, during different stages of your life. 400, Worcester, MA 01608, or send it by faxing 1-508-755 Learn about Fallon Health-Atrius Health Care Collaborative . EDI Coordinators (Electronic data The direct telephone number is 800-341-4848. org 1-800-341-4848 (TRS 711) M-F, 8 a. 1-844-403-1029. 835 Companion Guide. Community Health Plan (Fallon Health). If you have any questions about the program, contact your Provider Relations Representative. Atrius Health includes the practices of Dedham Medical Associates, Granite Medical Group, Harvard Vanguard Medical Associates, and PMG Physician Associates. Fallon-contracted doctors and providers can contact Fallon by phone or by email. Fallon Health is a leading health care services company that has been providing care to MassHealth members for over 45 years. Optum Prior Authorization Department P. The formulary, pharmacy network, and Our phone number is 1-877-700-6996 (TRS 711), 8 a. Skip to Main Content By phone at the number on the back of your ID card (TRS 711). To file the Request for Claim Review Form, mail or fax to: Mail: Fallon Health Attn: Request for Claim Review/Provider Appeals PO Box 211308 Eagan, MN 55121-2908 . Fallon Health Weinberg is looking to contract with high quality physicians and licensed health care practitioners who are willing to make a commitment to managed care. To log on: Our phone number is 1-877-700-6996 (TRS 711), 8 a. | Back to top | Question: Can another Fallon-contracted provider view my claims information? Answer: No, Fallon limits access to claims information by your provider identification number. netka njj fbqsl tibch gvwr qip wni erln xgnkqvgj enhpii

Fallon health provider phone number. Get care online or by phone.