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IHCS & Fallon Health Resource Center

IHCS serves as the value-based home health and durable medical benefit manager for Fallon Health. Below, find resources specific to Fallon Health’s providers, including clinical guidelines, provider resources, and compliance documentation.

Have questions?
IHCS:

Fallon Health:

Resources for Fallon Health Providers

Policies:

Medicare Advantage:

For Fallon Health members: IHCS will use NCDs/LCDs, Chapter 7 & 13 and if no policy exists, IHCS will default MA Plan Policy, and if no policy exists IHCS will default to MCG care guidelines and standard of care guidelines.

Medicaid:

For Fallon Health members: For Medicaid, IHCS uses State specific applicable policies where available, and if no policy exists, IHCS defaults to Health Plan policy and then to MCG care guidelines.

Commercial/ACA:

For Fallon Health members: Health Plan specific criteria, if applicable and if no policy exists, IHCS will default MCG care guidelines.

Resources coming soon...

Important Note:

There is no change in the DME list for Fallon Medicare Plus, Fallon Medicare Plus Premier, Premier Central HMO and NaviCare. Any DME item or home health service that currently needs prior authorization remains and must be submitted to IHCS starting on July 1, 2025.

To verify which item or service requires authorization, use the procedure code look-up tool at: https://fallonhealth.org/providertools/ProcedureCodeLookup (-> us-east-2.protection.sophos.com).

IHCS will coordinate your patient’s covered DME and home health services with an in-network Fallon Health provider, effectively reducing your administrative burden.