ProAuth FAQs

Last updated on January 23, 2020

How to use ProAuth

Authorization and referral process in ProAuth


How do I sign up for ProAuth?

You must complete the ProAuth enrollment form (also found on the Forms page). Once the form is completed, it should be sent to askfchp@fallonhealth.org.

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What browser should I use for ProAuth?

ProAuth runs best in Google Chrome. If Google Chrome is not installed on your computer, you can download it by searching “google chrome” in your browser and following the instructions to complete download. You may need to contact your helpdesk for admin rights or for assistance downloading Google Chrome.

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How do I change my password?

  • Log in to fallonhealth.okta.com.
  • From the user dashboard, click on the username in the top right-hand corner.
    Change password

  • From here, click on “Settings” then Edit Profile.
    Change your password

  • Verify your current password.
    Set your security settings

  • Click “Send email” to send the authentication code.
    Change password

  • Enter the authentication code from your email, and click “Verify.”
    Change password

  • Enter your old (current) password, then your new password (the one you wish to change to).
    Change password

    Password requirements: at least eight characters, a lowercase letter, an uppercase letter, a number and a symbol. Your password cannot be either of your last two passwords.
  • Click “Change Password.”

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What if I forgot my password?

  • Go to fallonhealth.okta.com.
  • Click “Need help signing in?
    Forgot password

  • Click on “Forgot password?”
    Forget password

  • Enter your email and select “Reset via Email”
    Forget password

  • You will receive confirmation that the email has been sent. Once you receive the email, click “Reset password.”
    Forget password

  • This will open your browser, and you will be prompted to answer your security question. Once you answer the question, click “Reset Password.”
    Forget password


  • Enter your new password twice and click “Reset Password.”
    reset pw

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What if I forgot my username?

Your username will always be your work email address.  If you have forgotten which email you registered with, please contact Fallon Health at 1-866-275-3247, option 6.

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What if I can’t see any providers in my list?

Your Provider Filter is in the upper right-hand corner of your screen. The providers available to you in your Provider Filter should be all providers in your office for which you issue/view referrals or authorizations on behalf of.

  • Search for a specific provider by entering the provider's individual NPI, or typing the provider's name.
  • Once you see your provider, check the box then click the “Apply Filter” button.

If you are entering the provider's information correctly and they are still not showing up in the search, please email askfchp@fallonhealth.org. If you are missing specific providers, please include the provider's NPI and name in your email.

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How do I look up referrals and authorizations previously issued by my provider group?

Chose a provider from the Provider Filter and then use the "Filter By" function on your dashboard. Expand the menu by clicking the plus/minus sign next to the “Filter By” title. Use the “Date of Service From Date” and “Date of Service To Date” to pinpoint a specific period of time in which referrals were entered for this provider to view ProAuth entries.

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How do I search for members to view/enter a referral or authorization?

Locating a member will allow you to view a summary of the patient, create an inpatient authorization or create a service (PCP Referral)/procedure authorization. Note: By default, your dashboard will appear empty.

  • From the ProAuth dashboard, select the “Member Search” option on the left side of the screen.

Search for members

  • From the member search tab, enter the member information. There are two ways to search for a member using ProAuth.

Method 1: Searching by member ID

You can search for a member using the member’s identification number.

  • Click “Search by ID” radio button.
  • Enter the full 13-digit identification number or enter the first 11 digits and the member’s date of birth.
  • Click “Search.”

Method 2: Searching by member name and date of birth

  • Click the “Search by Name and Date of Birth” radio button.
  • Enter the member’s first name, last name and date of birth.

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How do I name attachment files?

ProAuth requires specific naming conventions for files that are uploaded:

  • The attachment name cannot be over 100 characters long (including the extension).
  • No spaces are allowed in the file name.
  • The file name must be alphanumeric. Acceptable characters:
  • A-Z
  • a-z
  • 0-9
  • - (dash)
  • _ (underscore)
  • Any other characters are rejected with an error message.

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How do I add new users to ProAuth?

To add users, your Administrator will need to fill out the ProAuth enrollment form (also found on the Forms page). Once the form is completed, it should be sent to askfchp@fallonhealth.org.

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Where can I take the ProAuth training?

You can take training at Fallon Health's online University. If you do not already have a University account, you will need to click on “Request a new account”.

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How do I know if a specialist is in my provider group?

If you enter a PCP referral into ProAuth but a referral is not required, a message will pop up indicating that a referral is not required.

Most physician groups issue a list of participating providers for your reference. Additionally, you can use our Provider lookup tool.

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What if my office's firewall prevents me from attaching documents from the EMR to an authorization request?

You can fax supporting documentation to our Prior Authorization Department at fax number 1-508-368-9700. Please reference your pended authorization number.

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Can we have one default username and number for our office?

No. Every user must have a unique username and password for security purposes.

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What is the authorization number on the summary page?

This is your authorization number. It will be pended until a decision has been made by the plan, at which time you will see the decision and the number will stay the same and the status will change.

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Can I enter multiple CPT codes?

Yes. Please refer to the instructions provided for the specific procedure.

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If I fax in a prior authorization request, will it show in ProAuth, and for how long?

If you fax in a prior authorization request, it will show up in the dashboard in ProAuth with the status and will not go away once a decision is made, the status will just be updated.

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Can I access ProAuth if I am out of the country?

No, you will not be able to access ProAuth if you are not in the United States.

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What CPT code should I use for consultation and treatment services?

99429

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What if the office location in ProAuth for the specialist is not the location that I am referring to?

At this time there is only one location visible in ProAuth. As long as the provider name is accurate, the referral will process, regardless of referring location.

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How much time do I have to enter a retroactive PCP referral?

You must enter the PCP referral within 30 days past the date of service of the specialist visit.

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Do I need to include the NPI and/or PCP referral number on my claim?

No.

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Are there any authorizations that shouldn't go through ProAuth?

Yes. If you are submitting an authorization for one of the following types of services, you will need to submit them to one of our delegated entities:

  • High tech radiology – EviCore
  • Sleep studies and associated equipment (excluding NaviCare) – CareCentrix
  • Mental health – Beacon Health Options
  • Medical drug benefit – Magellan
  • Pharmacy drug benefit - Caremark

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Have additional questions?

Issue

Contact

ProAuth login issues (e.g. passwords)

Helpdesk (1-866-275-3247, prompt 6)

Training

Call your Provider Relations Representative

ProAuth entry issues

Care Services (1-866-275-3247, prompt 3)

Enrollment in ProAuth

Email: askfchp@fallonhealth.org

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