Electronic Data Submission

Fallon Health Weinberg accepts direct submission of Institutional and Professional claims, submitted in the HIPAA-compliant format.

Direct submission of claims

Submitting your claims directly to Fallon Health Weinberg eliminates the need for a clearinghouse and is offered with no transaction fee. Fallon Health Weinberg  offers the following ways to transmit your files: SFTP and Secure File Transfer.

Enroll to submit your claims directly to Fallon Health Weinberg

1. Download the Provider Tools Enrollment Form (pdf)
2. Complete the form and mail the registration information to:
   
   Fallon Health Weinberg
   Attn: EDI Coordinator
   10 Chestnut St.
   Worcester, MA 01608

Have a question? Contact our EDI coordinators at 1-855-827-2003.

Electionic submission of claims through a clearinghouse

Electronic claim submission offers quicker turnaround time, lower working costs, more efficient payments and a confirmation that claims have been received by the clearinghouse. Fallon Health Weinberg's EDI process is secure and HIPAA compliant. Please refer to the Billing Procedures Section of the Provider Manual to review our Electronic Data Transmission policies and procedures.

These items cannot be filed electronically:

• Status checks
• Invoiced items (such as supply charges for serum)
• Claims requiring attached documentation

Electronic claim submission companion guides 

• Benefit Enrollment and Maintenance ANSI X12 834 Version 4010 Implementation Guide 
• Health Care Claim Status Request and Response ANSI X12N 276/277 (Version 005010X212) Implementation Guide
• Health Care Claims Submission X12N 837 (Version 5010) Implementation Guide—Institutional
• Health Care Claims Submission X12N 837 (Version 5010) Implementation Guide—Professional
• Health Care Eligibility Benefit Inquiry and Response ASC X12N 270/271 (005010X279A1) Implementation Guide
• Health Care Payment/Advice ANSI X12 835 (Version 004010X091A1) Implementation Guide
• Premium Payment Submission ANSI X12 820 (Version 4010x61) Implementation Guide

Fallon Health Weinberg is contracted with the following clearinghouses.

Relay Health (formerly McKesson)
Call 1-800-735-2963, option 3, or visit their website at www.relayhealth.com.

Change Healthcare (formerly known as Emdeon and WebMD)
Call 1-800-845-6592 or visit their website: www.changehealthcare.com.

You must enroll with one of the above contracted clearinghouses prior to claims submission.

System downtimes 

Routine downtime is scheduled weekly from 7 a.m. to 10 a.m. on Sundays to support maintenance and enhancements for all EDI transactions. Non-routine downtime will be communicated via email at least one week in advance. Emergency unscheduled downtime will be communicated to trading partners via email within one hour following the determination that emergency downtime is needed