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 PA Department of Human Services) that serves as a guide for the delivery of services at all levels of care. For substance use disorder services, Beacon utilizes the American Society of Addiction Medicine Patient Placement Criteria (ASAM Third Edition, 2013) as a guide for the delivery of services at all levels of care.

The ASAM 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.