Welcome to the Provider Manual

The Fallon Health Provider Relations Department produces this manual for participating physicians, hospitals, ancillary providers and their support teams. The online Provider Manual represents the most current version available.

Table of contents

• Introduction (pdf) 
• Payment Integrity Program
• Fraud, waste and abuse policy (pdf)
• Sampling and extrapolation (pdf)
• Medical and behavioral health records (pdf) 
• Privacy and confidentiality (pdf)
• Fallon Health products (pdf)
• Managing patient care (pdf)
• Pharmacy (pdf)
• Doing business with Fallon Health (pdf)
• Peer review process (pdf)
• Credentialing process (pdf)
• Member appeals and grievances (pdf)
• Billing procedures (pdf)
• Payment policies 
• Forms 
• Medical policies