Massachusetts

 Behavioral Health Policy and Procedure Manual for Providers

 Massachusetts Medical Necessity Criteria

 Massachusetts Standard Form for Applied Behavior Analysis Services Prior Authorization Requests – MA Commercial Plans Only

 

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/ 

Claims resources

Wellpoint’s electronic Payer ID is WLPNT. For information about electronic transaction documents for Wellpoint claims, code sets, electronic remittance advice (ERA) registration, and more, please visit Wellpoint’s Filing Electronic Claims.

 

Important documentation

 Massachusetts Medical Necessity Criteria

 Policy and Procedure Manual

 Massachusetts Standard Form for Applied Behavior Analysis Services Prior Authorization Requests – MA Commercial Plans Only

 Wellpoint Provider Tip Sheet

Contact information

Customer service:
Credentialing and contracting
844-265-7592
Monday to Friday, 8 a.m. to 6 p.m. Eastern time

 

Provider relations:
Credentialing and contracting
844-265-7592
Monday to Friday, 8 a.m. to 6 p.m. Eastern time
 provider.relations@carelon.com

 

Wellpoint e-Solutions:
Claims questions
800-470-9630
Monday to Friday, 11 a.m.- to7:30 p.m. Eastern time
 e-solutions.support@wellpoint.com

 

Electronic data interchange (EDI) Helpdesk:
ProviderConnect technical questions
888-247-9311
Monday to Friday, 8 a.m. to 6 p.m. Eastern time

 

EnrollSafe – electronic claims:
Phone: 877-882-0384
Phone (EDI Solutions helpdesk): 800-470-9630
Website

 Senior Care Options 2024 Model of Care Training

Senior Care Options 2024 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 

 Behavioral Health Policy and Procedure Manual for Providers

 Massachusetts Medical Necessity Criteria

 Massachusetts Standard Form for Applied Behavior Analysis Services Prior Authorization Requests – MA Commercial Plans Only

 

Contact information:

Carelon Behavioral Health
500 Unicorn Park Drive
Woburn, MA 01801

 

Phone: 888-217-3501
Toll-Free: 877-957-5600
Fax: 781-994-7600
TTY: 711

 

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.

wellsense.org/contact-us 

Today we are Carelon Behavioral Health, but when some of these materials were developed, we were Beacon Health Options.