If you have questions about a determination for Substance Use Care, click the link below. All claims must be submitted within ninety (90) days of the discharge date or date of service. Copyright © 2020 Beacon Health Options. All rights reserved. Instructions and Help about submission claim form for beacon out of network. This form authorizes Beacon Health Options ® to receive and process claims electronically and certifies that claims will comply with all laws, rules and regulations governing your contract with Beacon Health Options ®. In the event paper claims must be used, claims for services must be submitted on one of the two National Industry Standard billing forms: the Center for Medicare and Medicaid Services Claim Form CMS-1500 (formally known as HCFA-1500) or the Uniform Billing Form UB-04/CMS-1450. It claims to be the largest privately held company of its kind in the United States. 200 State Street About Us. Providers who wish to have inquiry-only access to our system for the purpose of conducting eligibility inquiries and claim status inquiries must also submit this form. Provider Groups and Facilities may visit our provider portal or call our National Provider Service Line at 800-397-1630 to share your individual provider information. Beacon Health Options uses Beacon Health Medical Necessity Criteria to make certain public sector authorization determinations for Mental Health Care in New York. Health care providers can submit this form for services provided to patients. Beacon Health Claim Form. Behavioral health providers utilizing the Beacon Health Options site ("Providers") are solely responsible for determining the appropriateness and manner of utilizing Beacon Health Options information and resources in providing services to their patients. Fill out, securely sign, print or email your Outpatient Review Form - Beacon Health Strategies instantly with SignNow. INSURED’S I.D. Claims For general claim inquires, call 800-888-3944. Boston, MA 02109 Beacon Health Options Mental Health/Substance Abuse Treatment Claim Form. TO BE COMPLETED BY DOCTOR / HEALTH PROVIDER: Patient’s Name: Date Of Birth: (d/m/yr) Date of Visit Diagnosis/ICD Code Visit Type of Service Rendered Cost Further Services Or Service Fee Visit (drugs, injections, tests, supplies) Recommended Date of first symptoms: Has patient been previously treated for this condition? Member Name . Claim Submission; … Risk Adjustment: Key Points for Providers . Beacon Health Options Companion Guide •Located on the Helpful Resources page •Shows Beacon’s specific batch file requirements Reprocess and Voids •Beacon accepts frequency indicators of original (1), replacement (7), and void (8) Corrected claims can be completed as a replacement claim As a reminder, please ensure that you have completed your required Cultural Competency training. In order to facilitate payment of your claim, please be sure that Parts I and II are completed in their entirety. Risk adjustment coding tips to improve clinical documentation for providers. Home / Providers / Beacon Health Options / Forms Forms Download the forms you need for various administrative functions, such as billing and claims, provider leave notification, credentialing, member resources, and site review. You may also fill out and submit an online form on the Achieve Solutions website. The Alliance Claims Department is committed to processing your claims as quickly and accurately as possible. Copyright © 2020 Beacon Health Options. Note: This form is not applicable to health plans based in CT, PA, or NH. Claims Form. Phone Number . Beacon Health Options trabalha com seu plano de saúde para gerenciar os aspectos de saúde comportamental de seus cuidados de saúde. Beacon Health Options If you are a Practitioner, please visit CAQH, update your information, and attest that it is accurate. Please upload a file: Overview. Boston, MA 02109 Box 1853 Provider Name, Provider ID National Provider Identifier (NPI) Tax ID. Email . Fax: 781-994-7600. Beacon Health Options, Inc. (Beacon) is committed to helping providers manage administrative functions more effectively and efficiently, and encourages users to take advantage of Beacon’s online provider services. Adjustment Module: Changing or Reprocessing Professional Claims in ProviderConnect 1 Overview This function allows users to correct claims originally submitted by Direct Claim Submission, Batch Submission, or paper. Please review this guide and/or … Claims that are not submitted within the 90-day timeframe will not be considered for reimbursement. Beacon Health Options uses Medical Necessity Criteria to make authorization determinations for Mental Health Care. Claims Submission/ Address. For Professional Claims in ProviderConnect Revised – 03.16.2017 2 Direct Claim Submission At the ProviderConnect homepage, click on the “Enter a Claim” link. Guidelines for Treatment of General Anxiety Disorder in Adults in Primary Care. Tax Id is required. Step 2: Submit the form to Beacon Health Options. Beacon Health Options Submitting a claim to Beacon Health Options requires two easy steps. Claim Number (if known) When sending in a corrected claim via mail or fax, please include the following information: Reason for correction; Copy of the Provider Summary Voucher; Primary Insurance Explanation of Benefits (EOB) Please mail all correspondence regarding claims questions to: Beacon Health Options Pennsylvania Claims P.O. If you are in treatment with a non-participating Beacon Health Options, Inc. (Beacon) provider and your provider has indicated that you will be responsible to file your claim, please take this claim form with you to your visit. Don’t worry, be happy! Forms. Important Notice: ... W-9 form is available on the website. Beacon manages behavioral health services for Medical Assistance (MA) recipients in 12 Western Pennsylvania counties: Armstrong, Beaver, Butler, Crawford, Fayette, Greene, Indiana, Lawrence, Mercer, Venango, Washington, and Westmoreland. Submit this form for mental health/substance abuse treatment claims. Beacon Health Options, Inc. is a behavioral health company based in Boston, Massachusetts. If the listed address options are incorrect or out of date and you are a contracted provider or Fax: 781-994-7600. Electronic Payment Solutions and Remittance Advice. Available for PC, iOS and Android. through the ‘Beacon Health Options (formerly ValueOptions) Providers’ section of the website. Since 1999, Beacon Health Options has managed behavioral health services as part of the HealthChoices program. Enter your Beacon Health Options Provider Number and NPI # Enter your TAX ID. If you have questions about claims in general, call (800) 888-3944. Beacon Health Options of California, Inc., ValueOptions of Kansas, Inc., CHCS IPA, Inc., are all subsidiaries of Beacon Health Options, Inc. For purposes of this handbook, references to “Beacon” shall mean, individually or collectively, as applicable, the Beacon legal entity with whom provider has contracted to provide services with respect to a member. Sample Member Claims Form; Empire Claim Form; Authorization for Use or Disclosure of Medical Information; Autorización para que Beacon Health Options (Opciones de Salud de “Beacon”) divulgue información confidencial ; CMS-1500 Claims Form; Tips for Completing the CMS 1500; Outpatient-Review-Form; Frequently Asked Questions (PDF) Resources. Box 1800 Latham, NY 12110 PICA PICA 1. For providers interested in submitting claims electronically, please refer to “Andare in linea con Beacon Health Options ® ”. II. The company is the product of a 2014 merger between Beacon Health Strategies, LLC and ValueOptions, Inc. Request to Authorize ECT; Repetitive Transcranial Magnetic Stimulation (rTMS) Form. Please follow local notification processes. HEALTH INSURANCE CLAIM FORM. if you have troubles logging into the portal, please clear the cookies on your browser. Beacon Health Options 850 80 HEALTH INSURANCE CLAIM FORM New York State Government Employees Health Insurance Program 08/05 CHAMPUS 1500. Help : Provider Online Services Registration *Required fields are denoted by an asterisk ( ) adjacent to the label. All rights reserved. If you are in treatment with a non-participating B eacon Health Options, Inc. (Beacon) provider and your provider has indicated that you will be responsible to file your claim, please take this claim form with you to your visit. If you have questions about a determination for Mental Health Care, click the link for the level of care that applies below. Colocamos você no centro de tudo o que fazemos. If you have questions about a determination for Mental Health Care, click the link for the level of care that applies below. Electroconvulsive Therapy (ECT) Forms. 877-7NYSHIP (877-769-7447) Select Option 3 beaconhealthoptions.com Tips for Completing the CMS-1500 Claim Form This document is to help you provide valid information for timely payment of your claim. Tel: 888-204-5581 Download your claim form here, and have your doctor complete it. Beacon Health Options, Inc. is formerly known as ValueOptions, Inc. Beacon Health Options Guide to Changing or Reprocessing Claims in ProviderConnect. Providers who wish to have inquiry-only access to our system for the purpose of conducting eligibility inquiries and claim status inquiries must also submit this form. Beacon Health Options uses the ASAM Patient Placement Criteria to make authorization determinations for Substance Use Care. Complete your demographic and contact information . The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Video instructions and help with filling out and completing beacon health options claim form. Make edits where necessary and resubmit your claim. Beacon Health Options (Fallon, BMCHP, WellSense, Unicare) rTMS Authorization Request Form Health Insurance Claim Form. In order to facilitate payment of your claim, please be sur e that Parts I and II are completed in their entirety. This part is easy! Claims Submission Enhancements; Claim resubmissions and adjustments are now easier than ever through eServices. Please ask for the Healthy Kids or the Alliance Care IHSS Examiner when inquiring about claims for any of these programs. Simply search a member’s claim history under “Check Claim Status” to find the original claim. Download the forms you need for various administrative functions, such as billing and claims, provider leave notification, credentialing, member resources, and site review. The Claims Department works with the Department of Health Services (DHS) and EDS/Medi-Cal to maintain the most current Medi-Cal benefits and allowances. Start a free trial now to save yourself time and money! To obtain the complete ASAM medical necessity criteria for a specific level of care, please contact customer service at the number on the back of your ID card. Click on “Resubmit” and the new eClaim form will be auto-populated with the original claim data. 200 State Street Reference the address on the member’s identification card, as the address may vary based on payment location. This summary of Health Options Quality Improvement Program includes the goals and objectives of our program and expectations of providers to participate in quality activities. 4. HEALTH INSURANCE CLAIM FORM New York State Government Employees Health Insurance Program APPROVED BY NATIONAL UNIFORM CLAIM COMMITTEE 08/05 Please submit claims to: Beacon Health Options P.O. Paper Claims Submission Requirements . Member ID . Beacon Health Options (formerly ValueOptions) Members, Beacon Wellbeing: Employee Assistance Program, Beacon Wellbeing: Student Assistance Program, Authorization for Use or Disclosure of Medical Information, Autorización para que Beacon Health Options (Opciones de Salud de “Beacon”) divulgue información confidencial, Mental Health Parity Disclosures for Members in New York, Out-of-Network Emergency Services and Surprise Bills (NY only), Introduction to The ASAM Criteria for Patients and Families. This can be done via mail or the online claim submission process below. Check Benefits & Coverage . Provider's Contact Name is required. Tel: 888-204-5581 Forms Claims Form Sample Member Claims Form Empire Claim Form Authorization for Use or Disclosure of Medical Information Autorización para que Beacon Health Options (Opciones de Salud de “Beacon”) divulgue información confidencial CMS-1500 Claims Form Tips for Completing the CMS 1500 Outpatient-Review-Form Frequently Asked Questions (PDF) Resources Claim Submission Mental Health … Beacon Health Options (formerly ValueOptions) Members, Beacon Wellbeing: Employee Assistance Program, Beacon Wellbeing: Student Assistance Program. Beacon Outpatient. Beacon’s standards for claim turnaround time are to pay “clean claims” within 30 days of initial receipt. M EDICARE MEDICAID TRICARE CHAMPVA CHAM PUS GROUP HEA LTH A N F CA B K U G OTH R 1a. Online Claim Form . Claims – General Information. Beacon Health Options Home Provider Home Contact Us Log In. Claims should be mailed directly to the following address. 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