News and announcements

April 2019 Connection newsletter

• Provider Satisfaction Survey 
• Fallon partners with Vital Decisions 
• New plan designs 
• New Group Insurance Commission (GIC) tiers 
• NaviCare Model of Care training 
• Smoking cessation 
• Changes regarding claims with Zelis^TM edits 
• Serious Reportable Event reporting reminder 
• New Medicare opioid edits and programs 
• Validating your practice information 
• 5-Star rating from CMS 
• High-risk medication use in older adults 
• Osteoporosis management in older women 
• Colorectal cancer screening 
• Comprehensive diabetes care 
• Home health billing changes 
• Billing reminder 
• Adult foster care accreditation requirements

Read past issues of Connection

Pharmacy updates

• 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)
• New Medicare Opioid Edits and Programs for 2019 (pdf, 11/28/2018)
• Medicare formulary changes effective 1/1/2019 (pdf, 11/15/2018)
• Commercial formulary changes effective 1/1/2019 (pdf, 11/15/2018)

MassHealth
Beginning March 1, 2018, MassHealth members have more options for getting care, including MassHealth Accountable Care Organization (ACO) Partnership Plans.

• MassHealth ACO FAQs (7/16/2018)
• MassHealth 834 technical guidance (pdf, 3/8/2018)

Verify or update your practice information
Your practice information appears in our provider directories. Keeping your information current helps ensure that patients can locate and contact your practice.

• Fallon will collaborate with HCAS plans to streamline directory data updates (pdf, 9/6/2018)
• Provider Directory requirements from CMS and NCQA (pdf, 12/15/2016)