Training and resources

Orientations

Provider orientation (pdf)
Download and print the presentation about Fallon Health's products, network and using the Provider Tools. If you would like to schedule a meeting with your designated provider representative, please call the Provider Service Line at 1-866-ASK-FCHP, option 4, or send an e-mail to askfchp@fchp.org.

Product orientations

City of Worcester training presentation (pdf)
Provider orientation presentation for the plan specific to City of Worcester employees

Employee Advantage training presentation (pdf)
Provider orientation presentation for the plan specific to UMass employees

Steward Community Care training presentation (pdf)
Provider orientation presentation for Steward Community Care

Industry presentations

MGMA Payer Day presentation (pdf) (March 13, 2014)

MAPAM presentation (pdf) (May 23, 2013)

Fallon Health product information

Fallon Health product fact sheets

Healthy extras for Fallon Health members (pdf)
An overview of the programs that Fallon offers its members to keep them healthy

Product reference and member ID card guide (pdf) (March 2014)

Prior authorization

Pharmacy prior authorization procedures (pdf)

Radiology prior authorization guidelines
Prior authorization from MedSolutions (MSI) must be received before Fallon members can receive radiology services.

Referral and prior authorization procedures (pdf)

Sleep study and therapy management 

Resources

Frequently asked questions for providers

Forms
Links to the Forms section of the Provider Manual

Healthwise® Knowledgebase
Because your patients’ health is important to us, we want to help them make better decisions. This easy-to-use online health resource tool can assist you in encouraging your patients to optimize their health care.

HEDIS® measures Updated
Measures for preventive health care and condition-specific care.

ICD-10 implementation

Links to non-Fallon resources

Beacon Health Strategies
The Beacon Health Strategies Web site offers providers helpful, up-to-date information about behavioral health topics and benefits. Providers can find regularly updated "frequently asked questions," downloadable forms, eServices such as member eligibility verification and claims, and level-of-care information as well as clinical guidelines.

Massachusett Health Quality Partners (MHQP)
MHQP provides reliable information to help physicians improve the quality of care they provide their patients and help consumers take an active role in making informed decisions about their health care.

HealthCare Administrative Solutions, Inc. (HCAS)
HCAS was founded in January 2005 as the result of a commitment by leading Massachusetts health plans, including Fallon Health, to collaborate on administrative simplification initiatives for providers. Visit the HCAS site (the link above) for more information.