Provider Manual

MEDICAL NECESSITY CRITERIA

For mental health services, Beacon, in cooperation with its Clinical Advisory Committee, has developed Medical Necessity Criteria (approved by the Commonwealth) that serves as a guide for the delivery of services at all levels of care. For substance abuse services, Beacon has utilized the Commonwealth’s Pennsylvania’s Client Placement Criteria (PCPC) for adults and the American Society of Addiction Medicine Patient Placement Criteria (ASAM PPC-2) for children and adolescents.

The PCPC will serve as a guide for both network providers and Beacon Service Management staff for requesting and providing service authorizations.

Beacon may not arbitrarily deny or reduce the amount, duration, or scope of a required service solely because of the diagnosis, type of illness, or condition.