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:

The Direct plan

Download the Direct plan provider lists:

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.