News and announcements
Accountable Care Organizations
(ACO) claims submissions—what you should know
Please share with your Revenue Cycle/Operations teams.
Each year, Fallon Health is required to submit encounter data to the Commonwealth of Massachusetts for all ACO members. This submission includes final encounter data from claims with dates of service (DOS) in the prior calendar year.
To meet this requirement, all claims with DOS in calendar year 2025 must be submitted to Fallon Health no later than July 3, 2026. Submitting claims by this deadline ensures Fallon Health can report complete and accurate information to the State within required timeframes. Please note that timely filing limits apply.
Plans this affects:
- Fallon Health-Atrius Health Care Collaborative (FACC)
- Berkshire Fallon Health Collaborative (BFHC)
- Fallon 365 Care
Claim submission and correction guidelines
- First-time claims must be submitted within 120 days of the DOS, unless otherwise specified in your contract.
- Claim corrections must be submitted within 120 days of the most recent Remittance Advice Summary (RAS).
- Paper claim corrections must include a completed Request for Claim Review Form.
- Electronic claim corrections must be submitted with frequency code 7 or bill type 7, as applicable.
- Corrected claims must include all services/lines, not just the corrected line item.
If you have questions regarding claim submission or corrections, please contact your Provider Relations Representative.
Provider portal news
Our provider portal is designed to deliver a more streamlined,
efficient, and user-friendly experience for our contracted providers.
The portal offers a suite of features to simplify day-to-day operations, including:
- Eligibility and benefit verification
- Claim status checks
- Claims submission for 1500 claim forms
- Authorization and referral status tracking
What you need to know:
- Registration is required. (Your Provider Tools username and password will not work in the provider portal.)
- Registration will be handled by each organization’s super user. To get a username and password for the provider portal, find out who the super user is for your practice. That person will register you.
- If you will be the super user for your organization, register here.
About the super user role
Each provider group, defined by tax identification number (TIN), must designate at least one individual to be the super user (known as the practice administrator in the portal) to
manage portal access for their organization. Super users will:
- Serve as the primary contact for portal access
- Be responsible for setting up and maintaining user accounts
- Assign roles for claims, eligibility, benefits, and authorizations
- Approve third-party biller registrations
Log in to the provider portal ► | How to register ►
FAQs (coming soon) ► | Training videos ►
April 2026 Connection newsletter
- Provider payment processing transition to Zelis Payments Network
- Nurse triage vendor change
- IHCS update
- ALF invoice billing transition to ALF claims submissions
- Updated Medicare Outpatient Observation Notice (MOON)
- And more!
Read past issues of Connection
Pharmacy updates
Paper claims P.O. Box issues
When shipping paper claims that are not deliverable to a P.O. Box, (via FedEx etc.), please send to the following address:
Fallon Health Claims- Smart Data Solutions
960 Blue Gentian Road
Eagan, MN 55121
MassHealth
Verify or update your practice information
Your practice information appears in our provider directories. Keeping your information current helps ensure that patients can locate and contact your practice.