Provider Information

Caring for Our Communities | ACT 62 | Claims | Clinical/UM | Provider Enrollment | Provider Relations | Quality Mgt | Beaver | NWBHP | Formularies

Caring for Our Communities

Caring for Our Communities

• Caring for Our Communities – How do we pick ourselves up from the ashes of trauma and tragedy? How do we get through the everyday disappointments and setbacks of life? Life will get better, and we need to nurture a vision of how to make it better. Visit these resources for Beacon members and providers alike.

ACT 62

ACT 62 Information

• Autism Coverage – Acceptable Benefit Verification Information
• Beacon ACT 62 Fax Cover Sheet
• Frequently Asked Questions
• 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)
    • Adjustment Request
    • Authorization
    • Secondary Claims Adjustment
• Beacon Health Options Provider Guide to Using Direct Claim Submission
• Beacon Health Options Provider Guide to Changing or Reprocessing Professional Claims
• 5010 File Submissions
  • HIPAA 5010 Transition Frequently Asked Questions/General Information
  • 5010 Companion Guide
  • 5010 File Submission Testing Instructions
• Paper Claims Submission Requirements New
  • CMS-1500 Required Fields
  • UB-04 Required Fields

Clinical / Utilization Management

Clinical / Utilization Management

• Auto Auths
  • Auto Auth FAQs for Mental Health Services New
  • Auto Auth FAQs for Substance Use Disorder New
• Best Practice Guidelines
  • Adult Non-Acute Partial Hospitalization Program
  • Community Residential Rehabilitation (CRR) Host Home
  • Level 3B: Co-Occurring Substance Abuse and Mental Health Related Disorders in a Non Hospital Residential Treatment Facility
  • Level 3C: Medically Monitored Long-Term Residential
  • Suboxone New
  • RTF
• Case Conceptualizations and Treatment Recommendations from a Recovery Perspective
  • Evaluation Sample Part 1
  • Evaluation Sample Part 2
• Case Management Best Practice
• CCASBE 2 (LD) Data Definitions — Initial
  • Initial CCASBE 2 (LD) Template
• CCASBE 2 (LD) Data Definitions — Re-Evaluation
  • Re-Evaluation CCASBE 2 (LD) Template
• Opioid Addiction & Treatment Resources New
• Recovery Oriented Methadone (ROM) Phases of Treatment
  • Methadone Best Practice Guidelines for Providers

Provider Enrollment

Provider Enrollment

• Individual Preferred Provider Criteria for Sexual Offender Treatment
• Individual Preferred Provider Criteria for Treatment of Trauma
  • TF-CBT Brief Practice Checklist
• 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 Advisory Council Membership Directory
• Provider Covered Services Grid – HIPAA Compliant
• Re-Enrollment/Revalidation of Medical Assistance Providers

PA DHS/OMHSAS Information

• MA Bulletin: Statewide Preferred Drug List Implementation – Effective January 1, 2020
• 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

Quality Mgt

Quality Management

QM Program Highlights

• 2019 Quality Management Program Highlights

“Successful Transitions from Inpatient to Ambulatory Care” – Performance Improvement Project (PIP)

Project Description

• IPRO Report

Provider Information

• OMHSAS Letter

Discharge Management Planning

• DMP Chart Review Tool New
• DMP Reviewer Instructions
• DMP Baseline Results

Medication Adherence (SAA) Measure

• 2014 SAA Baseline Results

Tools

• Case Management
  • Data Definitions
• 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.

Clinical Practice Guidelines

Beaver

County Specific Provider Information

Beaver County

• System of Care

Formularies

Formularies

• Pennsylvania Medical Assistance Statewide Preferred Drug List Information