Electronic data submission

Electronic data submission of health care transactions provides quicker adjudication and processing of data. Due to the regulations imposed by the Health Insurance Portability and Accountability Act (HIPAA) of 1996, all formatting for electronic health care transactions must be in the ANSI X12 formats by October 16, 2003.

Fallon Health offers two methods of submission of health care transactions:

Direct submission to Fallon

You may submit claims directly to Fallon with no transaction fees. Direct submission requires that you submit health care transactions in the national standard formats. Fallon offers the following transmission methods:

  1. VPN
  2. Secure file transfer over the web (10 MB maximum file size).

If you are interested in submitting electronic health care transactions, please contact us at 1-866-275-3247, option 6, or email us to request to become a trading partner.

Our EDI coordinators will work with you to set up a username, password and mailbox. Next, we will perform testing to ensure that file transmissions meet HIPAA requirements. When testing is complete, you will be notified that Fallon is ready to receive production files.

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Clearinghouse submission

You may send claims to Fallon electronically by using a clearinghouse. To send your claims via this method, your office will need to enroll with one of Fallon's contracted clearinghouses. Once enrolled, all you need to do is send your claims data through to the chosen clearinghouse. The clearinghouse will then pass the file through standard data specifications and send it directly into our claims payment system.

Please note: You must be sure to notify a clearinghouse of your decision to submit claims to Fallon through their system before attempting to do so. You are required to provide NPI number to the clearinghouse.
Fallon currently contracts with:

Change Healthcare (formerly Emdeon and WebMD)
Call 1-800-845-6592 or visit their website: www.changehealthcare.com.
Payor ID #22254 for professional and institutional  

RelayHealth (formerly McKesson)
Call 1-800-735-2963, option 3 or visit their website: www.relayhealth.com.
Payor ID #3801 for professional and Payor ID #1576 for institutional

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