Eligibility help
Don't see your question listed here? Let us know and we'll work on adding it to our list!
Question:
What are the system requirements to use Provider Tools?
Answer:
The requirements to use the various Provider Tools, including electronic submission are:
- an Internet connection (56K modem or high-speed connection)
- a Web browser (We recommend Internet Explorer 5.x or higher.)
- a username and password supplied by FCHP
Download a current version of Internet Explorer.
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Question:
What if I need help using Fallon Community Health Plan's (FCHP) Provider Tools?
Answer:
FCHP will be happy to assist you. Please contact our EDI coordinators at 1-866-ASK-FCHP, extension 69968, or via e-mail.
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Question:
How can I give access to new employees and remove access for employees who no longer work for me?
Answer:
To obtain access for new employees, please complete a Provider Tool and electronic data submission Enrollment Form and send to:
Fallon Community Health Plan
Attn: EDI Coordinator
10 Chestnut St.
Worcester, MA 01608-2810
Please notify FCHP immediately at 1-866-ASK-FCHP extension 69968 to disable access for employees who have terminated employment. Also, if you feel the security of a password has been compromised, please notify FCHP immediately.
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Question:
How can I be sure the information is secure going over the Internet?
Answer:
This site uses 128-bit Secure Sockets Layer (SSL) encryption, the highest level of encryption currently available. Once you are logged into the FCHP site, all information transferred is sent using SSL. When you are accessing pages on www.fchp.org, there is a lock icon located on the bottom right of your browser window.
(here is what it looks like - )
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Question:
I verified that my patient was eligible using the Provider Tools, but my claim was rejected as "Reject not eligible"? How accurate is the information that Provider Tools uses?
Answer:
When verifying eligibility, Provider Tools uses up-to-date information at the time of your request. However, enrollment transactions may occur retroactively. Eligibility responses are not a guarantee of payment or authorization of services.
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Question:
I received an eligibility response of "Member Not Found." What does this mean?
Answer:
The response of "Member Not Found" identifies that this member has not been eligible with Fallon Community Health Plan (FCHP) for the past 120 days. You may search for dates of services 120 days in the past and 90 days in the future.
It also may indicate that an incorrect ID number, date of birth, or member name was entered. Please check the information and resubmit your inquiry.
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Question:
When searching for a patient's eligibility, "Contact Customer Service" appeared in place of a PCP name. What does this mean?
Answer:
If FCHP does not have a PCP on record for the member you're searching for, "Contact Customer Service" will be displayed as the PCP name and "1-866-ASK-FCHP, press 2" will be displayed as the PCP phone number in your search results. Please inform the member that they should contact FCHP at the phone number indicated to update their member information.
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Question:
Where can I find more information about Fallon Community Health Plan (FCHP) plans.
Answer:
FCHP's eligibility verification will identify the plan in which the member is enrolled. To find out more information please go to the Provider Manual or contact FCHP's Provider Relations Department at 1-866-ASK-FCHP, press 4.
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Question:
When verifying my patient's eligibility, I noticed that my phone number is incorrect. How can I update my information?
Answer:
Please call 1-866-ASK-FCHP, press 4 or send an e-mail.
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