What do I need to know?
The information in this communication is because you serve or could serve MetroPlus Health Plan members. Beacon Health Options is partnering with MetroPlus Health Plan to administer behavioral health benefits, as well as to develop and maintain the network of behavioral health providers.
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Beacon Health Options will be responsible to perform the following functions
|Credentialing and Contracting
(Beacon contracted providers only)
|Utilization Management (including member appeals)
|Claims Adjustment / Payment
|24 Hour Clinical Coverage
What is the contact information for Beacon?
Via the web: www.beaconhealthstrategies.com or https://provider.beaconhs.com
For MetroPlus Health Plan members: 1.855.371.9228
For provider referrals, authorization or clinical matters: 1.855.371.9228
For provider relations: 1.855.371.9228
For claims: 1.855.371.9228
For provider contracting: 1.781.994.7566
What benefits will Beacon manage?
What number should I call for authorizations for MetroPlus Health Plan members?
The phone number to call to obtain new authorizations for behavioral health, community and diversionary services is 1.855.371.9228. Requests for additional hospital days authorized prior to February 1 will continue to be authorized by MetroPlus until the member has discharged.
What services need authorization?
Acute and diversionary behavioral health services require telephonic prior authorization and continued stay authorization.
Outpatient psychotherapy requires authorization via eServices after 26 Initial Encounters (IEs) have been utilized. Requests for Psychological and Neuropsychological testing (with a Behavioral Health Diagnosis) require authorization via eServices prior to services being initiated. Please refer to the provider manual for additional information or call 1.855.371.9228.
What if I have a member who is inpatient on the effective date of the new relationship?
Members already admitted and have an open authorization with MetroPlus prior to February 1 should continue contact MetroPlus to request additional days until the member has discharged.
What level-of-care criteria will Beacon Health Options use with MetroPlus Health Plan members?
Providers can view and download a copy of the level of care criteria at https://provider.beaconhs.com
, by calling Beacon at 1.855.371.9228, or via eServices.
Note: Providers are required to ensure member meets Level of Care Criteria prior to the administration of services.
Where should I send my claims for behavioral health services?
Providers should submit claims for all MetroPlus Health Plan members to Beacon Health Options either through electronic data interchange (EDI) connection to Beacon or via Beacon’s eServices web application. EDI claims can be submitted directly by a provider, or through a billing intermediary.
- EDI: Providers or their billing intermediaries should email email@example.com for detailed information and to begin testing. 835/837 and 270/271 transactions are available. EDI and Emdeon claims require a plan ID associated with the levels of benefits.
- For Medicaid, Medicare and NY State Marketplace plan members please bill with plan ID 131
- For HARP members please bill with plan ID 141
- eServices: Please visit https://provider.beaconhs.com for information on the quick and easy registration process.
Beacon Health Options prefers to receive claims electronically. However, if you prefer to submit a paper claim, please send to:
Beacon Health Options
Attn: MetroPlus Claims Department
500 Unicorn Park Drive, Suite 103
Woburn, MA 01801
For more information on claims submission, please go to www.beaconhealthstrategies.com
and/or refer to Beacon’s provider manual available on our website.
What is Beacon’s timely filing rule?
The timely filing deadline for claims to be submitted to Beacon Health Options is 90 days from the date of service.
What are Beacon’s claims turnaround times?
If a “clean claim” (defined in Beacon’s provider manual) is submitted in a non-electronic format, the claim will be adjudicated no later than the 45th day after the date it is received. If a “clean claim” is submitted in an electronic format, Beacon Health Options will adjudicate the claim by the 30th day after the date it is received.
Will Beacon pay claims that are submitted by a non-behavioral health provider?
No. Beacon will only pay claims for covered services provided by a behavioral health provider as defined by the NY Department of Insurance.
Will there be a new Billing Guide for MetroPlus Health Plan members?
Beacon will develop and post on the Beacon website a provider manual for providers who provide services to MetroPlus Health Plan members before the start-up of behavioral health services. Contained within the manual will be a Claims/Billing section detailing our policies and procedures as well as other sections detailing covered services, the appeals process, quality programs and other relevant information.
What is Beacon’s reimbursement model?
Beacon uses various reimbursement methodologies. Beacon-contracted providers that provide services to MetroPlus Health Plan members will be paid according to their Beacon contracted rate.
How does Beacon Health Options’ partnership with MetroPlus Health Plan programs change my business?
Beacon Health Strategies’ partnership with MetroPlus Health Plan will require behavioral health providers to work directly with Beacon Health Strategies for MetroPlus Health Plan members.
Do I need to contract with Beacon?
Providers do have to be contracted with Beacon. If you are not currently contracted with Beacon you will need to submit a credentialing application and contract to join the Beacon network. During the interim, you will also be asked to sign a single case agreement that will provide you with useful and necessary information concerning the treatment of the member. The single case agreement will also provide you with the information Beacon will need to process your claim.
Whom can I call at Beacon to talk about contracting and/or the materials I have received?
Will MetroPlus Health Plan members retain their current ID numbers?
Yes. Members will retain their MetroPlus Health Plan ID number, which providers can use to identify members within the Beacon Health Strategies system.
Where should I check member eligibility?
Providers can check eligibility for all MetroPlus Health Plan members through Beacon Health Options eServices at https://provider.beaconhs.com
, or by calling Beacon’s automated eligibility line (IVR) at 1.888.210.2018 or via the 270/271 EDI transaction.
What should I expect from Beacon Health Options?
Providers and members should expect their relationship with Beacon Health Strategies to be a highly collaborative partnership giving providers the tools necessary to manage the care of the member. Beacon Health Strategies will focus on member outcomes and case management. Beacon Health Strategies’ encounter data, claims and other clinical and administrative processes are designed to offer superior mental health and clinical management information to network providers. This information will give providers the required tools to provide a high level of effective and efficient services to MetroPlus Health Plan members.
FOR PROVIDERS: MetroPlus Enhanced Plan (Health and Recovery Plan) & Medicaid Update
- Behavioral Health Drug Coverage Changes
(effective October 1, 2015)
Get More Info
Effective as of February 1, 2015