ACT 62 | Claims | Clinical/UM | Provider Enrollment | Provider Relations | Value Based Purchasing | Quality Mgt | Beaver | NWBHP | Formularies
ACT 62
ACT 62 Information
- Autism Coverage – Acceptable Benefit Verification Information
- Beacon ACT 62 Fax Cover Sheet
- Frequently Asked Questions
- BHRS ACT 62 – Quick Code Reference Guide
- ACT 62 Process Change—Effective 8/01/19
- When Does an ACT 62 Packet Need Sent for Authorization Purposes?
Claims
Claims Dept
- Appendix AA — Prior Authorization Requirements
- Paper Claims Submission Address: (For new and corrected paper claims) Beacon Health Options Pennsylvania Claims P.O. Box 1853 Hicksville, NY 11802-1853
- CMS-1500 Instructions
- CMS Place of Service Codes
- Explanation of Payment (EOP) Codes
- Free Medicare Consumer Workbook
- Frequently Asked Questions from the Member and Provider Service Representative
- ICD-10 Frequently Asked Questions
- National Provider Identifier (NPI) Frequently Asked Questions
- PaySpan Frequently Asked Questions
- PaySpan Payer User Guide
- PaySpan Provider User Guide
- CMS ICD-10 Code Lookup New
- Coding Conversion Tool New
- UB-04-CMS-1450 Instructions
- Beacon Billing Guide Revised
- Customer Service Audio Recordings (Helpful Tips)
- Beacon Health Options Provider Guide to Using Direct Claim Submission
- Beacon Health Options Provider Guide to Changing or Reprocessing Professional Claims
- 5010 File Submissions
- Paper Claims Submission Requirements New
Clinical / Utilization Management
Clinical / Utilization Management
- Auto Auths
- Best Practice Guidelines
- Case Conceptualizations and Treatment Recommendations from a Recovery Perspective
- Case Management Best Practice
- BHRS Recovery Toolkit
- CCASBE 2 (LD) Data Definitions — Initial
- CCASBE 2 (LD) Data Definitions — Re-Evaluation
- Opioid Addiction & Treatment Resources New
- Recovery Oriented Methadone (ROM) Phases of Treatment
- Review of Medical Necessity for BHRS
- TSS Scheduling Initiative
Provider Enrollment
Provider Enrollment
- Individual Preferred Provider Criteria for Sexual Offender Treatment
- Individual Preferred Provider Criteria for Treatment of Trauma
- Provider Advisory Council
Provider Relations
Provider Relations
- About Beacon
- Deficit Reduction Act
- HealthChoices BH Program-Program Standards and Requirements
- PROMISe Numbers and Service Locations
- PROMISe Enrollment Online
- Provider Covered Services Grid – HIPAA Compliant
- Re-Enrollment/Revalidation of Medical Assistance Providers
PA DHS/OMHSAS Information
- OMHSAS Policy Clarification #03-16-01: Encounter Coding
- OMHSAS Policy Clarification #01-14-01: Payment for Diagnostic Laboratory Services in Outpatient D&A Clinics
- DHS [55 PA CODE, CHAPTER 5260] Family Based Mental Health Services for Children and Adolescents
- MA Bulletin (99-10-14) Issued/Effective 12-01-10 “Missed Appointments”
- Program Standards & Requirements Appendix BB – DHS/OMHSAS – Regulations and Policies Not Applicable to HealthChoices
Value Based Purchasing
Value Based Purchasing
Inpatient Mental Health
- Inpatient Mental Health Value Based Purchasing Model
- Follow-Up After Hospitalization for a Mental Illness Provider Tip Sheet
- Follow-Up After Hospitalization CMS Measures Inventory Tool
Quality Mgt
Quality Management
QM Program Highlights
“Successful Transitions from Inpatient to Ambulatory Care” – Performance Improvement Project (PIP)
Project Description
Provider Information
Discharge Management Planning
Medication Adherence (SAA) Measure
Tools
- BHRS Unit Calculator Tool
- Case Management
- Chart Audit Tools
- Summer Therapeutic Activities Program (STAP)
- BHRS
- D&A Outpatient
- Family Based Mental Health Services
- Functional Behavioral Assessment (FBA)
- Inpatient Mental Health
- Medically Monitored Short and Long Term Residential (3B and 3C)
- Outpatient Mental Health
- Parent-Child Interaction Therapy (PCIT)
- Peer Support Services Documentation
- Residential Treatment Facilities (RTF)
Please note: The tools posted are used in the completion of routine documentation audits and may not include audit criteria for Quality of Care or Compliance related audits.
Beaver
County Specific Provider Information
Beaver County
Northwest Behavioral Health Partnership (this section is for NWBHP ONLY – Serving Crawford, Mercer & Venango Counties)
- Frequently Asked Questions (BHRS Providers only)
Formularies