Beacon provides clinical staff coverage 24 hours/day, 7 days/week, 365 days/year to respond to all member and provider calls, including emergent, urgent and routine calls.
All of Beacon’s UM decisions are based on Beacon’s Level of Care criteria (medical necessity). Financial incentives based on the number of adverse determinations or denial of payments by any individual involved in UM decision making is prohibited.
Informing Members of Their Rights
In addition to providing a posted statement of Member rights, Providers are also required to:
- Distribute and review a written copy Member Rights and Responsibilities at the initiation of every new treatment episode and include in the Member’s medical record documentation of this review.
- Inform Members that Beacon does not restrict the ability of contracted Providers to communicate openly with Members regarding all treatment options available to them including medication treatment regardless of benefit coverage limitations.
- Inform Members that Beacon does not offer any financial incentives to its contracted Provider community for limiting, denying, or not delivering medically necessary treatment to members.
- Inform Members that clinicians working at Beacon do not receive any financial incentives to limit or deny any medically necessary care.
