ACT 62 | Claims | Clinical/UM | Current Procedural Terminology (CPT) | 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
- How to Search for Authorization Letters on ProviderConnect
- How to submit IP MH auths via ProviderConnect
- BHRS Recovery Toolkit
- CCASBE 2 (LD) Data Definitions — Initial
- CCASBE 2 (LD) Data Definitions — Re-Evaluation
- Opioid Addiction & Treatment Resources New
- Resource Guide for CareConnect
- Recovery Oriented Methadone (ROM) Phases of Treatment
- Review of Medical Necessity for BHRS
- TSS Scheduling Initiative
Current Procedural Terminology (CPT)
Current Procedural Terminology (CPT)
Provider Enrollment
Provider Enrollment
- Individual Preferred Provider Criteria for Sexual Offender Treatment
- Individual Preferred Provider Criteria for Treatment of Trauma
- Provider Advisory Council
- Provider Advisory Council Mission Statement
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.
Clinician Toolkit: Assessment and Treatment of Suicidal Behaviors
- APA Suicidal Behaviors Guidelines
- Summary & Review: APA Suicidal Behaviors Guidelines
- APA Quick Reference Guide
- Suicide Risk Assessment Article
- Suicide Risk Assessment Form
Treatment Guidelines
- Diagnosis-Based Adherence Indicators for Inpatient
- Diagnosis-Based Adherence Indicators for Outpatient
- Treatment Guidelines for AD/HD – Reviewed May 8, 2014
- Treatment Guidelines for Major Depressive Disorder – Reviewed May 8, 2014
- Treatment Guidelines for Schizophrenia – Reviewed May 8, 2014
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