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/ 

Claims resources

UniCare’s electronic Payer ID is 80314. For information about electronic transaction documents for UniCare claims, code sets, electronic remittance advice (ERA) registration, and more, please visit UniCare’s Filing Electronic Claims.

 

Important documentation

Massachusetts Medical Necessity Criteria 

Policy and Procedure Manual 

Provider Support Tools Video 

UniCare 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

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

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

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 

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: 888-217-3501
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.