Training and resources
Fallon Health providers can complete required training online at no cost through The University. A wide range of topics is accessible in one convenient location.
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 1-866-275-3247, option 4, or send an email to firstname.lastname@example.org.
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
MGMA Payer Day presentation (pdf) (March 19, 2015)
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 2016) Updated
Pharmacy prior authorization procedures (pdf)
Radiology prior authorization guidelines
Prior authorization from eviCore healthcare must be received before Fallon members can receive radiology services.
Referral and prior authorization procedures (pdf)
Sleep study and therapy management
Frequently asked questions for providers
Links to the Forms section of the Provider Manual
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 Coding Tips Booklet (pdf) New
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.
Beacon Health Strategies PCP Toolkit New
Beacon’s PCP toolkit is an excellent resource for PCPs as they diagnose and treat behavioral health conditions.
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.