Fallon Community Health Plan

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Call us 1-800-868-5200 (TTY users, please call TRS Relay 711.)
         Monday through Friday, 8 a.m. to 6 p.m. Eastern time 

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  • Managing patient care
A doctor treats her patient
Providers

More you.
  • Provider Tools
  • Provider Manual
    • Introduction
    • Compliance and false claims acts
    • Medicare audit
    • Privacy and confidentiality
    • FCHP products
    • Managing patient care
    • Doing business with FCHP
    • Peer review policy
    • Credentialing procedures
    • Member appeals and grievances
    • Additional resources
    • Billing procedures
  • Medical management
  • Pharmacy
  • Connection newsletter
  • News and announcements
  • Resources
  • Frequently asked questions
  • Contact us

Managing patient care

Below is a list of topics included in the “Managing patient care” section of the Provider Manual. To view this section, click the link below.

  • Open the “Managing patient care” section of the Provider Manual

Topics

  • Medical management overview
  • Availability of providers
  • Accessibility of services
  • Admitting for inpatient stay or same–day surgery
  • Advance directives
  • Ambulatory cardiac monitoring
  • Behavioral health - mental health and substance abuse services
    • Children's Behavioral Health Initiative (CBHI)
    • Emergency Services Program Providers (ESP)
    • Community Service Agencies (CSA)
  • Care management
    • Disease Management
    • MassHealth Care Management Program
  • Chiropractic services
  • Dental benefits
    • FCHP MassHealth
  • Durable medical equipment (DME) and orthotic/prosthetic devices
  • Emergency care and urgent care
  • FCHP provider—definition and responsibilities
  • Hearing aids
  • Home health care providers
  • Hospitalization and skilled nursing facility admission
  • Interpreter services
  • Medical record standards
  • Network providers
  • Nurse Connect
  • Observation policy
  • Oral surgery
  • Out of area care
  • PCP referrals and plan prior authorization process
  • Peace of Mind Program™
  • Pharmacy
    • Commercial plans
    • FCHP MassHealth
    • Fallon Senior Plan with Medicare Part D prescription coverage
  • Podiatry
  • Radiology/imaging
  • Sleep management
  • Treatment of a minor without parental consent
  • Treatment options
  • Utilization statement

Quick links for providers

  • Eligibility verification
  • Claims metrics
  • Provider Manual
  • Provider Tools
  • Forms
  • Request information

More resources

Quick links

  • Members
  • Employers
  • Providers
  • Brokers
  • Fallon Senior Plan HMO - Medicare Advantage
  • Careers
  • News

Helpful tools

  • Find a doctor
  • Online drug formulary
  • Healthwise Knowledgebase
  • Provider Tools
  • Employer Tools
  • Quick Quote for Brokers
  • Well Now blog

Our plans and products

  • Insurance for businesses and municipalities
  • Fallon Senior Plan HMO - Medicare Advantage
  • NaviCare
  • Summit ElderCare (PACE)
  • MassHealth (Medicaid)

Employer group pages

  • City of Worcester Advantage
  • The Employee Advantage - UMass
  • Commonwealth of Massachusetts
  • Hanover
  • Federal Employee Health Benefits Program
  • Welcome, Worcester Academy employees

In memoriam
© 2012, Fallon Community Health Plan | All rights reserved. Web privacy policy
One Chestnut Place, 10 Chestnut Street, Worcester, MA 01608
1-800-868-5200 (TTY users, please call TRS Relay 711.), Monday through Friday, 8 a.m. to 6 p.m.,  Eastern time

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