Medical management

The resources you need to treat your Fallon Health patients effectively and efficiently.

Asthma tool kit
The resources in this kit are provided to assist you in caring for your patients with asthma. 

Care management programs
Information about the Cancer Support Program, radiology management (eviCore healthcare) and sleep management (Sleep Management Solutions)

Emergency Department Utilization Management program New!
When to go to the Emergency Department: Fallon Health’s message to our members

Forms 
Downloadable and printable forms most frequently needed by Fallon providers.

Health care guidelines
When should teenagers have an eye exam? How often should routine cholesterol screenings be conducted? View our recommended health measures and screenings.

NaviCare clinical practice initiatives
Documentation and guidelines for treating NaviCare members

Medical policies
Detailed documentation for all current medical policies for treating Fallon members

Payment policies
Payment policies and documentation for a variety of treatments and procedures

Proton pump inhibitors
We have removed the following PPI medications from our covered drug list: Prevacid, Prilosec, Protonix, Zegerid, lansoprazole, omeprazole and pantoprazole, and added a new prescription PPI called Kapidex to our formulary.

Referral and preauthorization process
Procedures and processes for referring patients and for requesting a preauthorization