Fallon Health
Fallon Health is a payer organization operating in Massachusetts. For an ASC, what matters isn't the logo. It's how Fallon Health pays: where it runs rich, where it runs thin, and how its reimbursement compares with peer plans for the same procedures.
Pilot Analysis
Get the complete Fallon Health analysis
Tell us where to send it. Our team will prepare an analysis of Fallon Health covering rates by code, market position, and underpaid areas, and email it to you within 5-10 business days. Need it faster? Book a demo.
What Insights reveals
How Fallon Health pays
See how Fallon Health reimburses across procedures and markets, benchmarked against the peer plans competing for the same cases. Not a raw rate sheet, a read on where it sits.
Geographic footprint
Fallon Health's presence spans Massachusetts. See where it concentrates and how that shapes the markets you compete in.
Peer position
Put your own position next to the benchmark for Fallon Health and bring the gap to your next contract conversation.
Specialty mix
Understand which procedures and specialties drive Fallon Health's volume, so you know where a rate change moves the needle.
Whether you're an ASC benchmarking a contract or a provider team looking Fallon Health up, DataLily AI maps how it reimburses across procedures and markets, and where your own rates sit against the peer benchmark.
Reference
Working with Fallon Health
- Payer ID
- FALLN is the EDI identifier used to route electronic eligibility checks (270/271), claim-status inquiries (276/277), and claims to Fallon Health through a clearinghouse.
- Eligibility verification
- Coverage and benefits for Fallon Health members are verified before the date of service, through a clearinghouse using payer ID FALLNor through the payer's provider portal.
- Prior authorization
- Requirements are set per plan and per procedure. Confirm whether an authorization is required with Fallon Health directly before the date of service.
Book a demo: pick a time
A 15-minute walkthrough of Fallon Health the way it pays.
- What is Fallon Health's payer ID?
- Fallon Health's electronic payer ID is FALLN. ASC billing teams use it to route eligibility checks (270/271), claim-status inquiries (276/277), and electronic claims to Fallon Health through a clearinghouse.
- How do ASCs verify eligibility for Fallon Health members?
- Eligibility and benefits for Fallon Health members are verified before the date of service, either electronically through a clearinghouse (a 270/271 transaction using payer ID FALLN) or through the payer's provider portal.
- Does Fallon Health require prior authorization for ASC procedures?
- Prior-authorization requirements for Fallon Health are set per plan and per procedure. Confirm whether an authorization is required with Fallon Health directly before the date of service.
- What type of payer is Fallon Health?
- Fallon Health is a payer organization operating in Massachusetts.
- How does Fallon Health compare with other payers for ASC procedures?
- Ask Rose and you get a plain-language read on where Fallon Health pays above or below peer plans for your top procedures, charted, and ending in a recommendation you can take into a contract conversation.
- Is Fallon Health paying my ASC below market?
- Put your own Fallon Health contract next to the peer benchmark in DataLily AI and you'll see the gap by procedure and market, the fastest way to know whether you're leaving money on the table.