Behavioral Health Policy and Procedure Manual for Providers
Carelon Behavioral Health
500 Unicorn Park Drive
Woburn, MA 01801
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
Electronic data interchange (EDI) Coordinators
866-275-3247, option 6
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.