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 Saint Vincent Hospital and Reliant Medical Group.

Tier 2: This tier include local providers affiliated with UMass Memorial.

Tier 3: This tier includes all other providers and hospitals in the Advantage Plan and Advantage Qualified High Deductible Plan with HSA networks.

Look up your tier:

The Direct plan

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.

* This tool is currently showing tiers for FY2020. Tiers will be updated for FY2021 on July 1.