Medical policies

Below are links to the most up-to-date policies on treatment options for Fallon Health members. Each policy includes an overview, policy and criteria, an explanation of when services are covered, and any exclusions that apply.

All policies are downloadable PDFs, unless otherwise noted.

The InterQual® criteria book view is available by logging into their transparency tool: InterQual medical necessity criteria.

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Please note: Registration for Provider Tools will close on June 30 while we prepare for our updated provider portal. This does not apply to ProAuth or SFTP.

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