Fallon Community Health Plan provider portal, phone and payer ID quick facts
| Provider resource entry point | https://www.fallonhealth.org/providers |
|---|---|
| Payer contact reference | 1-866-275-3247Provider Service Line: press 2 for member-claim questions; option 6 for EDI coordinators. |
| Claims payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| Eligibility payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| ERA payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for Fallon Community Health Plan. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
| Timely filing | Contracted: 120 days from service; noncontracted: one year |
| Prior auth route | Verify the current product policy and delegated reviewer; X12 278 support is not established by a portal link |
| Last reviewed | 2026-04-23 |
- Provider Service Line: press 2 for member-claim questions; option 6 for EDI coordinators.
- The April 2026 billing manual requires receipt within 120 days from service for contracted providers and within one year for noncontracted providers. Its mistaken-secondary-insurance exception uses 120 days from the other insurer EOB. Confirm product, contract and submission-type exceptions.
- This registry has not established a payer-specific appeal ladder for Fallon Community Health Plan. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
- This registry has not established one national ERA payer ID for Fallon Community Health Plan. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment.
Fallon Community Health Plan at a glance
| Legal name | Fallon Community Health Plan |
|---|---|
| Also known as | Fallon Health, FCHP, Fallon |
| Category | Commercial |
| Parent organization | Fallon Health |
| Claims payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| Eligibility (270/271) payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| ERA (835) payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for Fallon Community Health Plan. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
| NAIC company code | Not established in this registry |
| States covered | Massachusetts |
| Provider resource entry point | https://www.fallonhealth.org/providers |
| Provider phone | 1-866-275-3247Provider Service Line: press 2 for member-claim questions; option 6 for EDI coordinators. |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for Fallon Community Health Plan
The April 2026 billing manual requires receipt within 120 days from service for contracted providers and within one year for noncontracted providers. Its mistaken-secondary-insurance exception uses 120 days from the other insurer EOB. Confirm product, contract and submission-type exceptions.
| Submission type | Window |
|---|---|
| Initial claim reference | Contracted: 120 days from service; noncontracted: one year |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
This registry has not established a payer-specific appeal ladder for Fallon Community Health Plan. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: Fallon Community Health Plan provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Fallon Community Health Plan
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify Fallon Community Health Plan electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for Fallon Community Health Plan. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for Fallon Community Health Plan
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Fallon Community Health Plan volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| 270 / 271 eligibility | Listed in registry; verify current scope | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for Fallon Community Health Plan. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
portal_url
Source comparison: 2026-09-26
The official provider FAQ supplies the provider portal and current resources; existing public provider home remains the appropriate resource family.
Primary source for portal_urlprovider_phone
Source comparison: 2026-09-26
866-275-3247 is the Provider Service Line: press 2 for claims; option 6 for EDI.
Primary source for provider_phonetimely_filing_days
Source comparison: 2026-09-26
April 2026 manual pages 5 and 6 visually contradict unqualified 180 days: contracted claims 120 days fromDOS; noncontractedone year fromDOS. A specific mistaken-secondary-insurance exception uses 120 days from the other insurer EOB.
Primary source for timely_filing_dayselectronic_claims_supported / supports_279_271 / supports_278
Source comparison: 2026-09-26
FAQ documents 837 direct/clearinghouse options and excludes some submitter types; neither portal availability nor this finding certifies everyX12 transaction.
Primary source for electronic_claims_supported / supports_279_271 / supports_278
Not checked in this pass: Whole-record approval, legal identity, ownership and complete product coverage; Authenticated transactions and QuickIntell integrations; record_scope: Not verified by the retrieved sources in this bounded comparison; retain explicit uncertainty and do not infer from another field or organization.; payer_ids.claims: Not verified by the retrieved sources in this bounded comparison; retain explicit uncertainty and do not infer from another field or organization.; payer_ids.eligibility / payer_ids.era / era_payer_id: No current transaction-specific eligibility/ERA identifier evidence was verified; do not reuse claim identifiers.; appeal_levels / prior_auth_required_codes_sample / qi_module_coverage: Not verified by the retrieved sources in this bounded comparison; retain explicit uncertainty and do not infer from another field or organization..
Sources used for this guide
State coverage
Fallon Community Health Plan operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
Evaluate QuickIntell workflow fit for Fallon Community Health Plan
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for Fallon Community Health Plan; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Fallon Community Health Plan; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Fallon Community Health Plan before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Fallon Community Health Plan
Where is the Fallon Community Health Plan provider portal?
Use https://www.fallonhealth.org/providers as a starting point for Fallon Community Health Plan provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for Fallon Community Health Plan?
The April 2026 billing manual requires receipt within 120 days from service for contracted providers and within one year for noncontracted providers. Its mistaken-secondary-insurance exception uses 120 days from the other insurer EOB. Confirm product, contract and submission-type exceptions.
Does Fallon Community Health Plan publish a single claims payer ID?
This registry has not established one all-product claims payer ID for Fallon Community Health Plan. See the source findings for transaction-specific references. Look up the correct ID for the member's plan and transaction in your clearinghouse directory and verify against the member ID card before submission.
Does Fallon Community Health Plan accept electronic claims?
Verify Fallon Community Health Plan electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a Fallon Community Health Plan denial?
This registry has not established a payer-specific appeal ladder for Fallon Community Health Plan. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do Fallon Community Health Plan prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the Fallon Community Health Plan provider phone number?
This registry lists 1-866-275-3247 as a contact reference for Fallon Community Health Plan. Provider Service Line: press 2 for member-claim questions; option 6 for EDI coordinators.
Automate workflows around Fallon Community Health Plan requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against Fallon Community Health Plan's current published documents before submission. CPT® is a registered trademark of the American Medical Association.