Connection supplemental articles and policies - July 2014

Supplemental articles

Payment policies

(Fallon Health only)
Revised policies – effective September 1, 2014
The following polices have been updated; details about the changes are indicated on the policies.

  • Anesthesia Payment Policy – Updated the codes in the policy.
  • Nurse Practitioner Payment Policy – Updated the policy about acting as PCP for NaviCare members.
  • Radiology/Diagnostic Imaging Procedures Payment Policy – Updated referral/prior authorization discussion. MedSolutions prior authorization will apply to members enrolled through MassHealth.
  • Vaccine Payment Policy – Updated the codes in the policy.

Product spotlight

MassHealth providers

Urgent care centers offer prompt and convenient service

Urgent care centers are clinics that offer another care option for patients instead of going to an emergency room for common urgent-health issues. Recently, we mailed our MassHealth members a letter about these options, along with a list of urgent care centers.

As you know, the ER is the best place for critical medical conditions and trauma, but many common urgent-health issues can be addressed more promptly and cost effectively at urgent care centers. These centers usually have walk-in visits, later hours and offer a range of medical services.

When you can’t see patients yourself, we encourage you to refer our members to urgent care locations when appropriate—for minor injuries; fever or flu-like symptoms; sprains and strains; coughs, colds and sore throats; ear infections; and rash or other skin irritations.

Below is a list of urgent care centers available to Fallon MassHealth members.

Urgent care



CVS MinuteClinic®

Acton, Amesbury, Andover, Beverly, Charlton, Clinton, Danvers, Franklin, Grafton, Hudson, Maynard, Medford, Medway, Natick, Newton, Northborough, Salem, Sudbury, Tewksbury, Uxbridge, Watertown, Wellesley, Westford, Wilmington, Worcester





Reliant Medical Group
Urgent Care



Hallmark Health Urgent Care



CareWell Urgent Care



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Fallon Information Center Provider Speaker Series and more

If you’re in the Central Mass. area, stop by to visit us or encourage your patients to drop in to take a class or get a health screening at our Information Center in the White City Shopping Center, located on Route 9 in Shrewsbury. We’d love to assist you!

Summer classes and screenings:

  • Blood pressure screenings (free): 11a.m. to noon on Tuesdays, July 1, 15 and August 12
    Good for patients who need regular blood checks. No appointment necessary.
  • Gentle Yoga*: Every Tuesday, 10 a.m. to 11 a.m.
  • Yoga Flow*: Tuesdays, 6:15 p.m. to 7:15 p.m. and Thursdays (not July 3), 6:45 p.m. to 7:45 p.m.
    * There is a fee of $40 for 8 weeks.

Provider Speaker Series
We’re happy to continue our Provider Speaker Series this summer at the Information Center. All are welcome, but pre-registration is required because space may be limited. Call 1-866-209-5073 (TRS 711). For updates, visit

Family health history and you
Friday, July 11 – noon
Monday, August 11 – 6 p.m.
Lisa Price-Stevens, M.D., Medical Director for Fallon Total Caresm, will discuss potential connections between a person’s family health history and their health—now and in the future.

Communicating with your doctor
Monday, July 14 – 6 p.m.
Friday, August 8 – noon
Lisa Price-Stevens, M.D., Medical Director for Fallon Total Care, will talk to attendees about the importance of establishing an effective relationship with their PCP that is built on communication and trust.

Preventing Lyme disease
Friday, July 18 – noon
Monday, August 18 – 6 p.m.
Sarika Aggarwal, M.D., a practicing physician and Chief Medical Officer of Fallon Health, will discuss ways to protect yourself from tick bites, proper removal of attached ticks, and symptoms of the disease.

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Learn more about Fallon’s health and wellness programs

At Fallon Health, we recently streamlined and repackaged our many health and wellness programs and benefits under the umbrella name, The Well.

Our newly designed web page,, is a one-stop online resource to tap our many programs and services for people of all ages and health status. You’ll find more information about My Healthy Health Plan, It Fits!, Oh, Baby!, our care management programs for people who have chronic or complex health conditions, the worksite wellness programs we offer, a library of health-related flyers you can download, and much more.

We hope you’ll visit the site often and share this information with your patients. Or, for information about any of our programs, please call Provider Relations at 1-866-275-3247.

My Healthy Health Plan
In April 2013, Fallon Health launched a web-based wellness program, called My Healthy Health Plan (HHP), which rewarded our subscribers for being and becoming healthy and supports our mission, making our communities healthy.

Now, all eligible commercial plan members over the age of 18, in participating employer groups, can take full advantage of the program. They get $50 just for completing the HHP health assessment. From there, they have the opportunity to earn an additional $150 by participating in a customized action plan that may include regular health coaching, wellness workshops, interactive tools and more.

We want our members engaged in their health care and on the path to good health. By offering a health assessment, convenient options for coaching, nutrition and physical activity information and incentives, we hope our members can take advantage of the many ways Fallon is supporting their health and well-being—and will become more engaged patients.

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Fallon promoting health at FOX25 Zip Trips stops

We’ve been having fun meeting so many of our members during the FOX25 Zip Trip broadcasts we’re doing this summer—for the third year. We hope you’re tuning in!

We’re partnering with the Zip Trips broadcasts to promote our mission, making our communities healthy. Every Friday morning (6 a.m. to 10 a.m.) through August, Fallon will be visiting a new local community in Massachusetts (and one in New Hampshire) with our TV hosts and doing a special health segment on-air.

In July, Zip Trips will be in Orleans, Northbridge, Natick and Gardner. In August, Zip Trips will go to Salisbury, Bridgewater, Jamaica Plain, Rowley and Hingham. If you live/work around these towns, we hope you’ll encourage your patients to drop by—and we hope to see you in person, too! Visit (click the Zip Trips navigation bar) for more information.

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