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Provider Tools

Our web-based tools reduce paperwork, save valuable time, and improve communication—and they’re available at no cost.

ProAuth authorization tool

Enter referrals and authorizations and check status.
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Electronic Funds Transfer and 835 Claim Payment/Advice

Fallon Health offers Electronic Funds Transfer (EFT) and the 835 Health Care Claim Payment/Advice through PaySpan.
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Look-up tools

Login is not required for these applications.

  • Provider look-up
    Search for providers (including contracted individual and ancillary providers) by provider name, city, type, and other criteria.
  • Procedure code look-up
    A searchable library of all active CPT and HCPCS codes. The look-up provides preauthorization requirements.

Provider Tools available through Fallon Health's Provider Portal

  • Eligibility verification
    Verify that your patients are eligible for the date of service.
    Verify copayments, deductibles, and products.
  • Claims metric report
    Review your rejected claims with detailed rejection reasons.
    Review reports online or download to your computer.
  • Secure file transfers
    Protect personal health information through secure transactions.
  • PCP panel report
    View members on your PCP panel.
    See additions and deletions to your panel.
    Review reports online or download to your computer.
  • Referral monitoring report
    View claims and member information for referrals you've made.

Manage your Provider Tools user account and password

New updates to Provider Tools

We've updated the PCP Panel Report, Claims Metrics Report, and the Secure File Transfer tool to improve how they look on your mobile device.