Who to contact
For questions about error messages on the portal or outages:
mPulse Help Desk
1-877-814-9909
For all other questions or support:
Fallon Health's provider portal administrator
1-866-275-3247, option 4
askfchp@fallonhealth.org
Helpful tips for using the provider portal
Our provider portal offers a suite of features to simplify day-to-day operations for our providers and support staff who have direct contracts with Fallon Health.
This information below does not include everything about using the provider portal nor is it a full how-to manual. If you have specific questions about the provider portal that aren’t covered here, please contact the appropriate resource listed in the box to the right.
Topics
About the provider portal
The provider portal offers easy access to essential functions, including:
- View claims status
- Appeals submitted on behalf of a member
- Member eligibility verification
- View referrals and authorizations
- Member profiles
- PCP panel status and member rosters
- Secure messaging
- And more
It replaces the following legacy tools that were retired in December 2025:
- Eligibility verification
- Claims metric report
- PCP panel report
- Referral monitoring report
All of these functions are now accessed through the provider portal.
| Back to the top |
Registration
Super user role and responsibilities
To get started using the provider portal, each provider group or facility, defined by tax ID number, must designate at least one individual to be the super user to manage portal access for their organization.
Super users—referred to as practice administrators within the portal—will:
- Serve as the primary contact for portal access
- Register additional users and maintain user accounts
- Assign roles for claims, eligibility, benefits, and authorizations
- Approve third-party registrations
We recommend having two designated super users for each account, though this is not required.
Registration process
- Fill out the registration form.
- You will receive an email confirming receipt of your application.
- You will receive a second email once your registration is approved or denied. You must respond to the super user confirmation email within five business days, or your application will be denied.
Once registered and approved, the super user can add additional users and assign roles within the practice.
Super user FAQs
What if I’m the super user for multiple groups or practices that have different tax IDs?
If you are the super user for multiple tax identification numbers (TINs), you only need to register once. Please list additional TINs in the field labeled “Additional Access by TIN” during registration. Fallon Health will add the additional TINs upon approval. You can also email askfchp@fallonhealth.org to request access to additional TINs.
What happens if a super user leaves the practice?
It’s important to let us know a change needs to be made to the super user of a group or practice. This ensures that only active, authorized users retain access to the portal.
When a super user leaves a provider group or practice:
- A new super user must register and be approved by Fallon Health.
- If the newly assigned super user is already registered for the provider portal, please email askfchp@fallonhealth.org. Fallon Health will then update their role to practice administrator.
- Fallon Health will disable the former super user’s access once notified.
| Back to the top |
Registering and assigning user roles
After the super user has been approved by Fallon Health, they can add support staff for their group or practice.
Adding a new user
- Log in to the provider portal and access User Admin → User Maintenance.
- Select Add User.
- Enter the user’s information, including name, email, username, and password.
- Assign the appropriate role.
- Review and submit the registration. Be sure to click the Submit button.
- Check your email for a confirmation email. Then, forward that email to the new user. The new user will only get a copy of the confirmation email if the super user sends it to them.
- Securely share the username and password with the new user, and let them know they will be prompted to reset their password the first time they log in.
User roles
A user may only have one role per tax ID number, also called a TIN. Roles determine what a user can see and do in the portal, such as:
- Claims access
- Eligibility and benefits verification
- Authorization and referral status
- Eligibility
Each role is based on the user’s job responsibilities within the organization.
The available roles are:
- Practice administrator / super user
- Eligibility_Claims – Access to eligibility and claims
- Eligibility_Ref/Auth – Access to eligibility and referral/authorization status
- Eligibility_Claims_Ref/Auth – Access to all functions
Best practices for managing users and roles
- Assign only the access required for the role.
- Regularly review and update user permissions.
| Back to the top |
Member eligibility and benefits
Eligibility verification
You can verify a member’s eligibility by logging into the provider portal and using one of the following features:
- Office Management → Eligibility Search
- Patient Management → Patient Search
- Provider Home Page → Eligibility Search
The provider portal allows you to view:
- Policy effective dates
- Member date of birth
- Member ID
- Primary care provider (PCP) assignment
- Member plan/product type
The provider portal allows you to:
- Verify eligibility and benefits
- Review benefit-related information associated with the member’s plan, including deductible, copay, co-insurance, and out-of-pocket maximums for specific services
Please note: The provider portal does not display information regarding how much of a benefit has been used or what remains, such as chiropractic visits, PT/OT visits, or annual deductibles.
Member eligibility and benefits FAQs
What if eligibility information looks incorrect or inconsistent?
If eligibility data appears incorrect or inconsistent:
- Verify that you are using the correct member information.
- After typing a member’s information into Eligibility Search, click the Select button next to the member’s name for the most accurate information.
- Re-check eligibility using a different portal search method, such as Office Management or Provider Home Page.
Note: In some cases, you may see differences in eligibility details depending on how the search is performed. If there are still discrepancies, contact us for clarification at askfchp@fallonhealth.org.
What should I do if a member does not appear active?
If a member does not appear active:
- Re-check eligibility in the provider portal using all available search options.
- Confirm member information from the ID card, such as member ID and date of birth.
- If the issue persists, contact us at askfchp@fallonhealth.org.
Why is the primary care provider (PCP) not showing or showing incorrectly?
If PCP information is missing or appears incorrect:
- Confirm the member’s eligibility details and effective dates.
- Re-run the eligibility search using another portal view, such as Office Management or Patient Management.
- If PCP information is still missing or inaccurate, contact us at askfchp@fallonhealth.org.
What if I can’t access eligibility or benefits in the provider portal?
If you are unable to access eligibility or benefits:
- Confirm your organization has provider portal access.
- Verify that you have been assigned the appropriate role.
Important: If you are contracted with one of the vendors below and have questions regarding eligibility, referrals, or authorizations for Fallon Health members, please contact the appropriate vendor directly:
American Specialty Health (chiropractic)
1-800-848-3555 | ashlink.com
Carelon (behavioral health)
1-800-397-1630 | carelonbehavioralhealth.com
CareCentrix (Sleep Management)
1-866-827-2469 | carecentrixportal.com
DentaQuest (dental)
1-844-234-9829 | dentaquest.com
MassHealth ACO dental providers can find resources and contact information at the MassHealth Dental Program website.
EyeMed (Routine Eye Exams)
1-888-581-3648 | eyemed.com/en-us/provider
| Back to the top |
Claims
The provider portal allows you to:
- Submit new CMS 1500 claims
- View claim status and detailed claim information
- View claim denial reasons
- Search claims by member, provider, date, or claim number
- Generate and export claim status reports
- Access supporting documents through Document Manager
Submitting claims through the provider portal saves time with real-time validation and auto-populated fields, built-in code lookup tools, and, in some scenarios, automatic suggestion of modifiers.
Claims FAQs
Can I submit corrected or replacement claims?
No, at this time. Corrected or replacement claims cannot be submitted through the provider portal.
How do I check claim status?
Use either of the following options:
Option 1: Patient Management
- Select a patient.
- Use the Claim Status Search tool.
Option 2: Office Management
- Go to Claims.
-
Search by:
- Claim number, which is usually the fastest option
- Member ID or name
- Date of service or process date
- Provider or group
How do I see the reason a claim was denied?
- Go to Office Management and select View and Submit Claims.
- Use Claim Search to locate the desired claim by claim number, member, provider, or date range.
- From the Claim Status Search Results screen, click the hyperlinked Claim Number.
The Claim Status Detail screen will display detailed claim and service line information, including claim processing details and any associated denial reasons when applicable.
Where can I find my reports and exports?
You’ll find claims status reports, claims data, and other reports and exports in Document Manager.
Why can’t I see all claims?
You will only see claims associated with your provider’s registered tax ID.
| Back to the top |
Authorizations, referrals, and appeals
Through the provider portal, you can view referral and authorization status, but submitting referrals and authorizations cannot be done in the portal. That needs to be done through ProAuth.
|
|
Use |
| To submit |
Authorizations |
ProAuth or by faxing the standard prior authorization request form |
| Referrals |
ProAuth or by fax |
| Appeals |
Provider portal |
| To view status |
Authorizations |
Provider portal |
| Referrals |
Provider portal |
| Appeals |
By mail or by contacting Provider Services to request a status |
You can see past referrals and authorizations from 2 years prior in the provider portal.
Important notes:
- ProAuth is still required to enter referrals and authorizations.
- ProAuth requires a separate username and password.
- Not all provider types will have access to ProAuth.
Auths, referrals, and appeals FAQs
Do I register for ProAuth through the provider portal?
No. ProAuth registration remains unchanged. To register for ProAuth:
Can I submit appeals through the provider portal?
Yes. The provider portal allows providers to submit appeals on behalf of a member.
Why can’t I see appeal details or status updates?
At this time, status updates are provided via mail. Providers may also contact Provider Services to request a status update. Please note that real-time updates are not currently available in the provider portal.
Why don’t I see a referral or authorization in the provider portal?
It takes 1-2 business days for the referral or authorization to show up in the portal if you submitted it through ProAuth, but the timing varies if you submitted it by fax.
- Confirm it was submitted through ProAuth.
- Confirm that you have the correct role assigned to you by your super user. The following roles are given access to view authorizations and referrals:
- Eligibility_Ref/Auth
- Eligibility_Claims_Ref/Auth
- If it still isn’t appearing after a reasonable timeframe, contact us at askfchp@fallonhealth.org.
What if I do not have access to the Fallon Health provider portal or ProAuth?
Prior authorizations can be submitted to Fallon Health using the standard prior authorization form.
Who should I contact for appeals, referrals, or authorization questions?
Contact Provider Services at 1-866-275-3247, option 4, for:
- Appeal status inquiries
- Referral/authorization questions
Use the provider portal message center for non-urgent inquiries.
| Back to the top |
Message center
The provider portal includes a secure message center, allowing users to submit inquiries to specific Fallon Health departments.
Available inquiry types include:
- EDI
- Clinical/care management
- Enrollment, benefits, and claims
- General inquiries
When you click Submit, the following message will appear:
“You’ll receive a response in 1 to 3 business days. If you have an urgent issue, please contact Fallon Health Provider Services at 1-866-275-3247, option 4.”
| Back to the top |
Training and support
| Back to the top |