Training and resources

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Provider training

The University 
Fallon Health providers can complete various trainings online at no cost through The University. A wide range of topics are accessible in one convenient location.

Available trainings include:

  • MCO, Navicare fact sheet
  • ASAP training
  • ACO fact sheets

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Product-specific information

Product reference and member ID card guide (pdf) (April 2018)

GIC tiering information

ID card app for mobile devices

Guidelines and requirements for NaviCare members in long-term care facilities (pdf)

Prior authorization

Pharmacy prior authorization procedures (pdf)

Radiology prior authorization guidelines
Prior authorization from eviCore healthcare must be received before Fallon members can receive radiology services.

Referral and prior authorization procedures (pdf)

Sleep study and therapy management 

Resources

Cultural competency

Frequently asked questions for providers

Forms
Links to the Forms section of the Provider Manual

Healthwise® Knowledgebase
Because your patients’ health is important to us, we want to help them make better decisions. This easy-to-use online health resource tool can assist you in encouraging your patients to optimize their health care.

HEDIS® measures
Measures for preventive health care and condition-specific care.

Links to non-Fallon resources

Beacon Health Options 
The Beacon Health Options website offers providers helpful, up-to-date information about behavioral health topics and benefits. Providers can find regularly updated "frequently asked questions," downloadable forms, eServices such as member eligibility verification and claims, and level-of-care information as well as clinical guidelines.

Beacon Health Options PCP Toolkit
Beacon’s PCP toolkit is an excellent resource for PCPs as they diagnose and treat behavioral health conditions.

Massachusett Health Quality Partners (MHQP)
MHQP provides reliable information to help physicians improve the quality of care they provide their patients and help consumers take an active role in making informed decisions about their health care.

HealthCare Administrative Solutions, Inc. (HCAS)
HCAS was founded in January 2005 as the result of a commitment by leading Massachusetts health plans, including Fallon Health, to collaborate on administrative simplification initiatives for providers.