Resources for providers

Get the online tools and resources you need to take care of your patients who are Fallon Health members.

Quick links

Proauth webinars

Please join us for upcoming training on how to submit and view Prior Authorization requests in Proauth:
November 23, 2021 12-1 p.m.  Join the Microsoft Teams meeting
December 8, 2021 9-10 a.m.  Join the Microsoft Teamsmeeting
December 21, 2021 10-11 a.m.  Join the Microsoft Teams meeting

Opioid management program and pain management alternatives

July 2021 Connection newsletter 

  • MassHealth provider enrollment
  • COVID-19 vaccine ordering update
  • CareConnect—nurse triage enhancements to help members get connected to their PCP
  • Botox billing update
  • Gene therapy drug authorization management change
  • Prior authorization process enhancement
  • More details about Fallon’s predominant focus on offering government-sponsored health insurance programs such as Medicare and Medicaid

Medical Rx program
Fallon Health Medical Pharmacy Prior Authorization Program (.pptx)
Webinar recording

Medication Administration Visits (MAV) codes
ACO home health providers: Our claims system has been adjusted and is now accepting Medication Administration Visits (MAV) codes T1502 and T1503. Effective August 14, 2019, providers may start submitting claims for these service codes. These MAV codes require prior authorization. Previously denied claims due to “not a covered benefit” are being processed retroactive to March 1, 2018. Please contact your Provider Relations Representative if you have any questions.

Fallon will collaborate with HCAS plans to streamline directory data updates (7/16/2019)
Watch for more information in upcoming issues of the Connection newsletter.

Provider Directory requirements from CMS and NCQA 9/10/2017
The Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA) have enacted requirements that health plans engage providers in reviewing and maintaining provider directory information.

More news and announcements

Have questions?

Contact your Provider Relations Representative: