Fallon Community Health Plan

Fallon Community Health Plan was paid $92K by Medicaid between Jan 2018 and May 2023, across 6 billing codes. Its largest line is 99308, Subsequent nursing facility care, per day, straightforward — 67% of everything it billed.

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2018	1,768	$36K
2019	1,998	$39K
2020	387	$17K
2022	46	$0.00
2023	39	$642.51

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
99308	Subsequent nursing facility care, per day, straightforward	67%	2,753	2,652	$62K
99309	Subsequent nursing facility care, per day, low to moderate complexity	15%	515	494	$14K
99307		14%	817	773	$13K
99318		3.4%	68	68	$3K
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	<1%	12	12	$642.51
99385		0%	73	73	$0.00

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.

From NPPES

Who's on the registration

Authorized officialGOHEEN, CHARLES (CHIEF FINANCIAL OFFICER)