Claims help

Don't see your question listed here? Let us know and we'll work on adding it to our list!

Question:
What are the system requirements to use Provider Tools?

Answer:
The requirements to use the various Provider Tools, including electronic submission are:

  • an Internet connection
  • a web browser
  • a username and password supplied by Fallon Health

Download a current version of Internet Explorer.

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Question:
What if I need help using Provider Tools?

Answer:
We will be happy to assist you. Please contact our EDI coordinators at 1-866-275-3247, option 6, or via email.

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Question:
How can I give access to new employees and remove access for employees who no longer work for me?

Answer:
To obtain access for new employees, please complete a Provider Tool and electronic data submission Enrollment Form (pdf) and fax it to 1-508-368-9996 OR send to:
Fallon Health
Attn: EDI Coordinator
10 Chestnut St.
Worcester, MA 01608-2810

Please notify Fallon immediately at 1-866-275-3247, option 6 to disable access for employees who have terminated employment. Also, if you feel the security of a password has been compromised, please notify Fallon immediately.

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Question:
How do I search by account number or claim number?

Answer:
All searches require that a claim status be selected. When searching by account number or claim number, select the claim status of "All."

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Question:
How can I be sure the information is secure going over the Internet?

Answer:
This site uses 128-bit Secure Sockets Layer (SSL) encryption, the highest level of encryption currently available. Once you are logged into the Fallon Health site, all information transferred is sent using SSL.

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Question:
Can another Fallon-contracted provider view my claims information?

Answer:
No, Fallon limits access to claims information by your provider identification number. Fallon is committed to keeping information secure and confidential.

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Question:
How do I download a claims metric report?

Answer:
One-click reports are always in the format of a download. When running search criteria, you are given the option to "view results on-screen" or "download to file." Choose "download to file." Your data will be transmitted in a comma separated, or ".csv," format. Click Continue from the claims download page. Note that the approximate size and time to download will display based on your Internet connection. Next, a file download box will appear, and you have the option to open the file or save the file to your computer. Open the data using a spreadsheet application (such as Microsoft Excel), and you then may sort the data in any way that you choose.

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Question:
I am successful at downloading files, but it takes a lot of time. Is there a faster way?

Answer:
How fast your file downloads depends on the size of the file and your Internet connection method. Broadband connection via cable or DSL will result in much faster downloads than a 56K modem connection.

You may also limit your search criteria by selecting a specific claim status at a time.

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