Prospective operative note review process

Effective January 1, 2014, claims received at Fallon Health changed from a retrospective claim review of surgical codes to a prospective claim review. The dollar threshold is $1,000 for professional claims and $5,000 for facility claims. The retrospective review process for claims received in 2013 remains in effect.

Where to send operative notes:

  • Fax: 1-508-368-9094
  • Secure email:
  • Mail: Fallon Health
    Claims Administration
    PO Box 211308
  • Eagan, MN  55121-2908

Include the following information:

  • Member name
  • Date of birth
  • Fallon member ID number
  • Date of service
  • Claim number