Information for providers

The City of Worcester Advantage plans have two distinct networks: Advantage and Direct.

The Advantage plan: Tiering

• Tier 1: This tier includes local providers affiliated with UMass Memorial, Saint Vincent Hospital and Reliant Medical Group. Members will pay a lower copayment when they see a provider in Tier 1.
  
  
• Tier 2: This tier includes all other providers and hospitals in the Advantage plan network.

Look up your tier:

• Provider Look-up tool
• Advantage plan participating hospital list (pdf)

The Direct plan

• Provider Look-up tool
• Direct plan participating hospital list (pdf)

Provider Tools

Our web-based tools reduce paperwork, save valuable time, and improve communication—and they’re available at no cost to you!

For access to:

• Eligibility verification
• Claims metric report
• Secure file transfers
• PCP panel report
• Referral monitoring report

please visit the Providers' section on www.fallonhealth.org.