Provider and pharmacy directory

This directory provides a list of the NaviCare network plan providers, including physicians, specialists, hospitals, pharmacies and other providers.

• Download the NaviCare HMO SNP and NaviCare SCO Plans Provider and Pharmacy Directory  (H9001_N_2013_7 Accepted, pdf)
  This directory provides a list of the NaviCare network plan providers, including physicians, specialists, hospitals, pharmacies and other providers. This directory is current as of August 31, 2012. Some plan providers may have been added or removed from the list after this directory was created.
• Use our Find a Doctor tool to find a NaviCare provider
  (This link will bring you outside of NaviCare's specific website pages. To find NaviCare providers, go to the "Advanced Search" section, pick "Search a specific plan's network," and then choose "NaviCare" as your plan.) To get the most up-to-date information about NaviCare plan providers in your area:
• Current members call:
  1-877-700-6996 (TTY users, please call TRS Relay 711), Monday through Friday from 8 a.m. to 8 p.m. (From October 1 through February 14, we're available seven days a week.)
• Prospective members call:
  1-877-255-7108 (TTY users, please call TRS Relay 711), Monday through Friday from 8 a.m. to 8 p.m. (From October 1 through February 14, we're available seven days a week.)

---

How to get care from out-of-network providers

You may get services from out-of-network providers when providers of specialized services are not available in network. For services to be covered from an out-of-network provider, your in-network provider (usually your PCP) must request prior authorization (approval in advance) from NaviCare. The prior authorization request will be reviewed by Fallon Community Health Plan’s Utilization Management Program staff that are trained to understand the specialist’s area of expertise and will attempt to ascertain if that service is available within NaviCare’s network of specialists. If the service is not available within your plan’s network, your request will be approved. There may be certain limitations to the approval, such as just one initial consultation visit or a specified type or amount of services. If the specialist’s services are available within your plan’s network, the request for services outside of the network may be denied as “services available in network”. As with any denial, you will have the ability to appeal the determination.

 

 

NaviCare is a Coordinated Care plan with a Medicare contract and a contract with the Massachusetts Medicaid program. NaviCare is a voluntary program in association with MassHealth/EOHHS and CMS.

To view the PDF files above, you may need to download a free copy of Adobe^® Acrobat Reader software on your computer. (This link takes you away from the NaviCare-specific website pages.)

Adobe is a registered trademark of Adobe Systems Incorporated.

 H9001_N_2013_15 Approved 10292012

The information on this page was last updated on 10/1/2012.