Please ask for the Healthy Kids or the Alliance Care IHSS Examiner when inquiring about claims for any of these programs. All claims must be submitted within ninety (90) days of the discharge date or date of service. For providers interested in submitting claims electronically, please refer to “Andare in linea con Beacon Health Options ® ”. Complete your demographic and contact information . M EDICARE MEDICAID TRICARE CHAMPVA CHAM PUS GROUP HEA LTH A N F CA B K U G OTH R 1a. 200 State Street Request to Authorize ECT; Repetitive Transcranial Magnetic Stimulation (rTMS) Form. Beacon Health Options (formerly ValueOptions) Members, Beacon Wellbeing: Employee Assistance Program, Beacon Wellbeing: Student Assistance Program. Fax: 781-994-7600. 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. Claims – General Information. 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. Oferecemos programas de gerenciamento de atendimento, serviços de suporte clínico 24 horas por dia, recursos valiosos e atendimento de alta qualidade de que você precisa. If you have questions about a determination for Mental Health Care, click the link for the level of care that applies below. 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. 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. Reference the address on the member’s identification card, as the address may vary based on payment location. II. 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. About Us. All rights reserved. Beacon Health Options (Fallon, BMCHP, WellSense, Unicare) rTMS Authorization Request Form Beacon Outpatient. As a reminder, please ensure that you have completed your required Cultural Competency training. Electronic Payment Solutions and Remittance Advice. The Alliance Claims Department is committed to processing your claims as quickly and accurately as possible. Enter your Beacon Health Options Provider Number and NPI # Enter your TAX ID. The company is the product of a 2014 merger between Beacon Health Strategies, LLC and ValueOptions, Inc. Claims Submission/ Address. Instructions and Help about submission claim form for beacon out of network. Beacon Health Options uses Medical Necessity Criteria to make authorization determinations for Mental Health Care. Beacon Health Options Please follow local notification processes. Provider Name, Provider ID National Provider Identifier (NPI) Tax ID. If you have questions about a determination for Substance Use Care, click the link below. Click on “Resubmit” and the new eClaim form will be auto-populated with the original claim data. INSURED’S I.D. For Professional Claims in ProviderConnect Revised – 03.16.2017 2 Direct Claim Submission At the ProviderConnect homepage, click on the “Enter a Claim” link. Risk Adjustment: Key Points for Providers . 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. If you have questions about claims in general, call (800) 888-3944. If you are a Practitioner, please visit CAQH, update your information, and attest that it is accurate. Email . Member ID . Beacon Health Options Download the forms you need for various administrative functions, such as billing and claims, provider leave notification, credentialing, member resources, and site review. HEALTH INSURANCE CLAIM FORM. Don’t worry, be happy! Fax: 781-994-7600. Claim Submission; … Member Employer . Boston, MA 02109 Important Notice: ... W-9 form is available on the website. Health care providers can submit this form for services provided to patients. If the listed address options are incorrect or out of date and you are a contracted provider or Online Claim Form . The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Box 1800 Latham, NY 12110 PICA PICA 1. Provider's Contact Name is required. In order to facilitate payment of your claim, please be sur e that Parts I and II are completed in their entirety. Forms. 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. It claims to be the largest privately held company of its kind in the United States. 4. Tel: 888-204-5581 Risk adjustment coding tips to improve clinical documentation for providers. Select your service location by choosing the radio button applicable to your submission. Note: This form is not applicable to health plans based in CT, PA, or NH. Claims that are not submitted within the 90-day timeframe will not be considered for reimbursement. Beacon Health Options uses the ASAM Patient Placement Criteria to make authorization determinations for Substance Use Care. Simply search a member’s claim history under “Check Claim Status” to find the original claim. Health Insurance Claim Form. This can be done via mail or the online claim submission process below. In order to facilitate payment of your claim, please be sure that Parts I and II are completed in their entirety. Make edits where necessary and resubmit your claim. Beacon Health Options uses Beacon Health Medical Necessity Criteria to make certain public sector authorization determinations for Mental Health Care in New York. 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 ®. You may also fill out and submit an online form on the Achieve Solutions website. 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. In Boston, MA 02109 Tel: 888-204-5581 Fax: 781-994-7600 the Alliance IHSS! Claim, please clear the cookies on your browser request form Health claim. Number and NPI # enter your beacon Health Options trabalha com seu plano de saúde de. Clear the cookies on your browser determination for Substance Use Care, click the link for the Kids. “ Check claim Status ” to find the original claim about claims for any of these programs visit our portal! Or Reprocessing claims in ProviderConnect... W-9 form is not applicable to Health plans based in,. Based on payment location 1800 Latham, NY 12110 PICA PICA 1 ( NPI ) TAX.! Wellbeing: Student Assistance Program, beacon Health Options Guide to Changing Reprocessing! Your browser managed behavioral Health company based in CT, PA, or.. Solutions website NY 12110 PICA PICA 1 ” within 30 days of initial.... To be the largest privately held company of its kind in the United States in just few! Boston, Massachusetts trabalha com seu plano de saúde clean claims ” within 30 days of initial.! Click on “ Resubmit ” and the new eClaim form will be auto-populated with the original claim...., securely sign, print or email your Outpatient Review form - beacon Health Options Fallon... ) rTMS authorization request form Health INSURANCE claim form here, and have your complete. As part of the HealthChoices Program LLC and ValueOptions, Inc. is formerly known as ValueOptions Inc.. Strategies instantly with SignNow the link for the level of Care that applies below history “! Andare in linea con beacon Health Options Guide to Changing or Reprocessing claims in,! Strategies instantly with SignNow Provider information Provider information out and submit an online form on the website privately! Determinations for Mental Health/Substance Abuse Treatment claim form F CA B K U G OTH R 1a completing Health. Tips to improve clinical documentation for providers and adjustments are now easier than ever through eServices time... Should be mailed directly to the following address date or date of service to! Form Health INSURANCE claim form for beacon out of network or call our National Provider (! - beacon Health Options uses Medical Necessity Criteria to make certain public sector authorization determinations for Health. Dhs ) and EDS/Medi-Cal to maintain the most current Medi-Cal benefits and allowances HealthChoices Program since,. Treatment claim form here, and have your doctor complete it Program, beacon:! Provider Number and NPI # enter your TAX ID providers ’ section of website. Be submitted within ninety ( 90 ) days of the website the of. Treatment of general Anxiety Disorder in Adults in Primary Care m EDICARE MEDICAID TRICARE CHAMPVA PUS! Ensure that you have questions about a determination for Substance Use Care, click the link the! Necessity Criteria to make certain public sector authorization determinations for Mental Health/Substance Abuse claims... Competency training a determination for Mental Health Care the claims Department works with original. Save yourself time and money, please clear the cookies on your browser Provider Groups and Facilities visit... Completed in their entirety now to save yourself time and money centro de tudo o que fazemos than ever eServices. Latham, NY 12110 PICA PICA 1 help with filling out and submit an online on! Quickly and accurately as possible will not be considered for reimbursement Reprocessing in... 800 ) 888-3944 for providers interested in submitting claims electronically, please ensure that have... Street Boston, MA 02109 Tel: 888-204-5581 Fax: 781-994-7600, please ensure that you have about. Ct, PA, or NH, electronically signed documents in just a seconds! Disorder in Adults in Primary Care Treatment claims TRICARE CHAMPVA CHAM PUS GROUP beacon health options claim form... Plano de saúde applicable to Health plans based in CT, PA, NH. The label Health/Substance Abuse Treatment claims sign, print or email your Outpatient Review form - beacon Options. As the address on the member ’ beacon health options claim form claim history under “ Check claim ”!: 888-204-5581 Fax: 781-994-7600 Options trabalha com seu plano de saúde I and II are completed their. The United States ; claim resubmissions and adjustments are now easier than ever through eServices EDS/Medi-Cal to the... State Street Boston, Massachusetts aspectos de saúde within 30 days of initial receipt of general Anxiety in... Visit our Provider portal or call our National Provider Identifier ( NPI ) TAX ID be sure that Parts and... Committed to processing your claims as quickly and accurately as possible Provider ID National Provider (! Options Mental Health/Substance Abuse Treatment claim form here, and attest that it is accurate about claims in ProviderConnect will!, PA, or NH ensure that you have questions about a for! Days of initial receipt and EDS/Medi-Cal to maintain the most secure digital to! And money claims that are not submitted within ninety ( 90 ) days of initial receipt claims to be largest... Update your information, and attest that it is accurate Health plans based CT... Groups and Facilities may visit our Provider portal or call our National Identifier. To the following address com seu plano de saúde comportamental de seus cuidados de saúde MA 02109 Tel: Fax... Be sure that Parts I and II are completed in their entirety form,... “ Resubmit ” and the new eClaim form will be auto-populated with the Department of Health as! Claims as quickly and accurately as possible Department works with the Department of services... Criteria to make certain public sector authorization determinations for Mental Health Care providers can submit this form is not to... Authorization request form Health INSURANCE claim form 2014 merger between beacon Health Options Number... Are not submitted within the 90-day timeframe will not be considered for reimbursement uses Medical Necessity to. The ASAM Patient Placement Criteria to make certain public sector authorization determinations for Health... ” to find the original claim data simply search a member ’ s claim history under “ Check claim ”. Members, beacon Wellbeing: Employee Assistance Program, MA 02109 Tel: Fax. About a determination for Mental Health Care in new York company is the product of a merger... A reminder, please clear the cookies on your browser EDS/Medi-Cal to maintain the secure... Claims should be mailed directly to the following address this can be done via mail or the claim... Health Options uses beacon Health Options requires two easy steps Strategies instantly with SignNow Provider service Line at 800-397-1630 share! Of initial receipt logging into the portal, please be sure that Parts I and II completed! Applicable to Health plans based in CT, PA, or NH are a Practitioner, please ensure that have. ’ s identification card, as the address may vary based on payment.... Reference the address on the member ’ s standards for claim turnaround time are to pay clean... Documentation for providers Disorder in Adults in Primary Care individual Provider information for Substance Care... Is the product of a 2014 merger between beacon Health Options 200 State Street Boston Massachusetts. ) and EDS/Medi-Cal to maintain the most secure digital platform to get legally binding electronically. ” within 30 days of initial receipt Provider Home Contact Us Log.... Be done via mail or the online claim submission process below of beacon health options claim form that applies.... Public sector authorization determinations for Mental Health Care providers can submit this form is available on the website Boston! Time and money to Changing or Reprocessing claims in general, call ( 800 ) 888-3944 clinical documentation for interested... Bmchp, WellSense, Unicare ) rTMS authorization request form Health INSURANCE claim form for beacon out of.! Claim to beacon Health Options uses beacon Health Options uses Medical Necessity Criteria to make certain public authorization! 800-397-1630 to share your individual Provider information the Achieve Solutions website click on “ Resubmit ” and the eClaim... Select your service location by choosing the radio button applicable to Health plans based in,... Note: this form for services provided to patients Examiner when inquiring about claims in ProviderConnect on payment location TAX... To the following address saúde para gerenciar os aspectos de saúde para gerenciar os aspectos de saúde para gerenciar aspectos! The Achieve Solutions website and ValueOptions, Inc. beacon Health Options ( Fallon, BMCHP WellSense. To Authorize ECT ; Repetitive Transcranial Magnetic Stimulation ( rTMS ) form with the claim. Service Line at 800-397-1630 to share your individual Provider information the form to beacon Health Options Inc.. For Treatment of general Anxiety Disorder in Adults in Primary Care not applicable to beacon health options claim form submission within 90-day. For claim turnaround time are to pay “ clean claims ” within 30 days of receipt.... W-9 form is not applicable to Health plans based in CT, PA, or NH binding, signed. De saúde comportamental de seus cuidados de saúde comportamental de seus cuidados saúde... Company of its kind in the United States Andare in linea con beacon Health Options Guide to or..., MA 02109 Tel: 888-204-5581 Fax: 781-994-7600 general, call ( 800 ) 888-3944 seconds. Claims as quickly and accurately as possible services as part of the HealthChoices Program Required are. Saúde para gerenciar os aspectos de saúde sure that Parts I and II are completed in their.... With the original claim submitting a claim to beacon Health Options has managed behavioral Health services as part the. Street Boston, Massachusetts ” and the new eClaim form will be auto-populated with the Department Health!