News and announcements
Paper claims P.O. Box issues
When shipping paper claims that are not deliverable to a P.O. Box, (via FedEx etc.), please send to the following address:
Fallon Health Claims- Smart Data Solutions
960 Blue Gentian Road
Eagan, MN 55121
Opioid management program and pain management alternatives
July 2020 Connection newsletter
- Changes to Claim Reversals on the EDI 835 Remittance Advice
- COVID-19, HEDIS 2020 and Pay for Performance
- PrEP Therapy
- Sampling and Extrapolation Process
- Medicare Non-Formulary Quantity Limit (NF+QL) Program
- Medicare Medication Therapy Management Program—MDLink™
Read past issues of Connection
Pharmacy updates
- Commercial and Medicaid formulary changes effective 10/15/2020 (pdf, 9/15/2020)
- Non-formulary quantity limit program (pdf, 5/12/2020)
- Ranitidine (zantac) recall
- MDLink Medicare MTM Program (pdf, 4/3/2020)
- Voluntary Site of Service Program (pdf, 4/1/2020)
- Opioid management program
- New Medicare Opioid Edits and Programs for 2020 (pdf, 12/11/2019)
- New medical benefit pharmacy program (pdf, 9/10/2019)
- FAQs
- Webinar recording
- Medical benefit drugs requiring PA and drugs subject to claim edit review, effective January 1, 2020 (pdf, 11/18/19)
- Commercial and Medicaid formulary changes effective 6/10/2019 (pdf, 6/10/2019)
- Commercial and Medicaid formulary changes effective 4/13/2019 (pdf, 3/1/2019)
MassHealth
Beginning March 1, 2018, MassHealth members have more options for getting care, including MassHealth Accountable Care Organization (ACO) Partnership Plans.
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