Massachusetts

 Behavioral Health Policy and Procedure Manual for Providers

 Massachusetts Medical Necessity Criteria

Contact information:

Carelon Behavioral Health
500 Unicorn Park Drive
Woburn, MA 01801

Phone: 888-421-8861
Fax: 781-994-7600
TTY: 711

Monday to Friday, 8 a.m. to 6 p.m. Eastern time

Carelon Behavioral Health provides clinical staff coverage 24 hours day, 7 days per week, 365 days per year to respond to all member and provider calls, for emergent and urgent care.

Fallon Health Plan Provider Relations Department
866-275-3247
 askfchp@fallonhealth.org

Electronic data interchange (EDI) Coordinators
866-275-3247, option 6
 edi.coordinator@fallonhealth.org

Please contact FCHP to get information on the following important topics:

• How to change your primary care doctor.
• How to get a referral to specialty care.
• How to appeal a health plan decision.
• How to issue a complaint.
• What benefits and services are included in, and excluded from your coverage, including pharmacy and how to request changes to these benefits.
• Co-payment information.
• Getting care when you are away from home, or after office hours.
• How to get reimbursed for an out-of-pocket expense for covered services.
• How your health plan evaluates new technology for inclusion as a covered benefit.

fallonhealth.org/ 

 Senior Care Options 2023 Model of Care Training

Senior Care Options 2023 Model of Care Attestation 

 Behavioral Health Policy and Procedure Manual for Providers

Contact information:

Carelon Behavioral Health
500 Unicorn Park Drive
Woburn, MA 01801

Phone: 855-833-8125
Fax: 781-994-7600
TTY: 711

Monday to Thursday, 8:30 a.m. to 6:00 p.m and Friday: 8:30 a.m. to 5:00 p.m. Eastern time

Carelon Behavioral Health provides clinical staff coverage 24 hours per day, 7 days per week, 365 days per year to respond to all member and provider calls, for emergent and urgent care.

Provider referrals, authorization, or clinical matters: 866-444-5155
Provider relations: 781-994-7556 or  Provider.relations@carelon.com
Claims: 888-249-0478
Fax: 781-994-7639

wellsense.org/contact-us