Service authorization form template update#
Service authorization form template registration#

The following form is applicable to all business except health plans based in AR, CO, CT, HI, GA, KS, MA (Medicaid), NH, PA, or WA. If you become aware of a Potential Quality of Care (PQOC) Concern, please report the PQOC Beacon immediately, and no longer than 1 business day. Beacon tracks, investigates, and works to proactively address Potential Quality of Care Concerns. Reporting a Potential Quality of Care Concern to BeaconД«eacon is committed to ensuring that Beacon members receive safe, high quality care.

Service authorization form template update#

Psychological/Neuropsychological Testing Update.2019 Psychology and Neuropsychology Testing and Evaluation Service Codes Frequently Asked Questions (FAQ).Psychological/Neuropsychological Evaluation Request.Beacon Health Options (Commercial Contracts) rTMS Authorization Request Form.Beacon NY Health Plan (Affinity, MetroPlus, IHA) rTMS Authorization Request Form.Beacon Health Options (Fallon, BMCHP, WellSense, Unicare) rTMS Authorization Request Form.Repetitive Transcranial Magnetic Stimulation (rTMS) Form Use for authorization requests for inpatient and all alternative/higher levels of care. Some contracts require that requests only be submitted via the web. Some contracts allow only telephonic review if web service is not utilized. Please confirm for a specific contract that forms are allowed. If you are unable to complete the request online, please contact customer service by dialing the toll-free number on the memberвЂ™s health benefit insurance card to obtain information on the correct procedure to utilize.ДЇaxed or mailed forms should only be submitted to the specific fax or address. After hour requests, occurring past normal business hours on Friday or Saturday, may be called in as well.Д¬ontinue to submit Residential, Partial, and Intensive Outpatient service requests online. Alternatively, you may contact us by dialing the toll-free number on the memberвЂ™s health benefit insurance card to complete a telephonic review during normal business hours Monday through Friday. Please submit requests via our secure HIPAA-compliant provider portal. Beacon Health Options is no longer accepting faxed Inpatient Treatment Review (ITR) requests for Acute Mental Health or Acute Detox Services for its commercial contracts. Inpatient and Higher Levels of Care Authorization RequestsДЇor most efficient and timely service - use of authorization request flow on our provider portal is the preferred method of submitting requests. New York State OASAS Notification of Admissions for Outpatient Substance Use Disorder (SUD) Services.Required for New York Medicaid, CHP, Essential, and Commercial plans. New York State OASAS Notification of Admission for Inpatient and Residential Substance Use Disorder (SUD) Services.Only use this form if you are credentialed to offer medication management services.

Service authorization form template registration#

Medication Management Registration Form.

Florida Outpatient Treatment Review Form (FL-OTR form).

Faxed or mailed forms should only be submitted to the specific fax or address. For most efficient and timely service вЂ“ use of authorization request flow on our provider portal is the preferred method of submitting requests.