Provider and Pharmacy Directory


This directory provides a list of the NaviCare network plan providers, including physicians, specialists, hospitals, pharmacies and other providers. If you would like a Provider and Pharmacy Directory mailed to you, please complete our online form.

  • Download the NaviCare HMO SNP and NaviCare SCO Plans Provider and Pharmacy Directory (H9001_N_2017_7_NM, pdf)
    This directory is current as of April 20, 2017. Some plan providers may have been added or removed from the list after this directory was created.
  • Use our Find a Doctor tool to find a NaviCare provider
    (This link will take you away from NaviCare's website.) To find NaviCare providers, go to the "Advanced Search" section, pick "Search a specific plan's network," and then choose "NaviCare" as your plan.
  • To get the most up-to-date information about NaviCare plan providers in your area:
  • Current members call:
    1-877-700-6996 (TRS 711),  8 a.m.–8 p.m., Monday–Friday.
    (Oct. 1–Feb. 14, seven days a week.)
  • Prospective members call: 
    1-877-790-4971 (TRS 711), 8 a.m.–8 p.m., Monday–Friday.
    (Oct. 1–Feb. 14, seven days a week.)

We make sure you get the care you need

If you’re seeing an out-of-network provider when you first enroll with NaviCare, we will work with you to make sure you continue to get the care you need. Your Navigator will talk to you about your options when you join.

Getting care from out-of-network providers as a NaviCare member

As a NaviCare member, you may get services from out-of-network providers when providers of specialized services are not available in network. For services to be covered from an out-of-network provider, your in-network provider (usually your PCP) must request prior authorization (approval in advance) from NaviCare. Fallon Health’s Utilization Management staff will review the prior authorization request. This team is trained to understand the specialist’s area of expertise and will determine if that service is available within NaviCare’s network of specialists.

If the service is not available within your plan’s network, your request will be approved. There may be certain limitations to the approval, such as just one initial consultation visit or a specified type or amount of services.

If the specialist’s services are available within your plan’s network, the request for services outside of the network may be denied as “services available in network.” As with any denial, you will have the option to appeal the determination.

 

 

Fallon Health is an HMO plan with a Medicare contract and a contract with the Massachusetts Medicaid program. Enrollment in Fallon Health depends on contract renewal. NaviCare is a voluntary program in association with MassHealth/EOHHS and CMS. NaviCare SCO is available to anyone age 65 and older who has MassHealth Standard and lives in the service area. Individuals who also have Medicare Parts A and B may enroll in NaviCare HMO SNP. The provider network and/or pharmacy network may change at any time. You will receive notice when necessary. To view the PDF files above, you may need to download a free copy of Adobe® Acrobat Reader software on your computer. (This link takes you away from the NaviCare website.) Adobe® is a registered trademark of Adobe Systems Incorporated.

H9001_N_2017_16 Approved 10142016
The information on this page was last updated on 10/1/2016.