News and announcements
The new provider portal is here!
Our new provider portal is designed to deliver a more streamlined,
efficient, and user-friendly experience for our contracted providers.
What’s new? The enhanced portal will offer a suite of features to simplify day-to-day operations, including:
- Eligibility and benefit verification
- Claim status checks
- Claims submission for 1500 claim forms
- Authorization and referral status tracking
What you need to know:
- Registration is required. (Your Provider Tools username and password will not work in the provider portal.)
- Registration will be handled by each organization’s super user. To get a username and password for the provider portal, find out who the super user is for your practice. That person will register you.
- If you will be the super user for your organization, register here.
- Existing Fallon Health provider tools will be retired in mid-December 2025.
About the super user role
Each provider group, defined by tax identification number (TIN), must designate at least one individual to be the super user (known as the practice administrator in the portal) to
manage portal access for their organization. Super users will:
- Serve as the primary contact for portal access
- Be responsible for setting up and maintaining user accounts
- Assign roles for claims, eligibility, benefits, and authorizations
- Approve third-party biller registrations
Log in to the provider portal ► | Register ►
FAQs (coming soon) ► | Training videos ►
IHCS provider trainings.
Learn more ►
October 2025 Connection newsletter
- New provider portal launches 10/22/25
- New option for aging in place in SE Mass
- MassHealth ACO formulary updates
- HOPA effective 1/1/26
- NaviCare® sleep management by CareCentrix 1/1/26
- And more!
Read past issues of Connection
Pharmacy updates
Fallon Health has a process in place to expedite network credentialing for all health care providers that are affected by the closures at Carey Hospital and Nashoba Valley Medical Center. Please email Fallon Health Credentialing at credentialing@fallonhealth.org to request expedited credentialing. To ensure that your credentialing file can be expedited, please make sure that CAQH is updated with all required documentation.
Community Care Qualifying Payment Amount (QPA) for non-contracted providers
New federal and state requirements concerning surprise billing have taken effect. Fallon Health recently began paying out-of-network claims for the Community Care product pursuant to the federal No Surprises Act. The allowed amount for out-of-network claims covered by the No Surprises Act will be set at the Qualifying Payment Amount (QPA).
- Fallon Health is working with our vendor partner ClearHealth to identify claims subject to the No Surprises Act and to determine the appropriate QPA.
- For any claims paid in accordance with the No Surprises Act, the Fallon Remittance Advise (RAS) will note at a claim line level “Paid according to the qualifying payment amount (QPA), as defined by the No Surprises Act Regulations.” A Provider Adjustments and Appeals letter with additional details will be included with the RAS.
- If an out-of-network provider or facility wishes to initiate a 30-day open negotiation period for purposes of determining the amount of final payment to the provider or facility, they may contact ClearHealth via the secure portal https://provider.clearhs.com or by calling (866) 722- 3773.
Paper claims P.O. Box issues
When shipping paper claims that are not deliverable to a P.O. Box, (via FedEx etc.), please send to the following address:
Fallon Health Claims- Smart Data Solutions
960 Blue Gentian Road
Eagan, MN 55121
MassHealth.
Verify or update your practice information
Your practice information appears in our provider directories. Keeping your information current helps ensure that patients can locate and contact your practice.