The Provider Handbook outlines the Beacon Health Options, Inc. (Beacon) standard policies and procedures for individual providers, affiliates, group practices, programs, and facilities. Providers are encouraged to carefully review this Handbook as well as visit the Network-Specific Websites to verify which policies and procedures are applicable to them.
This handbook is an extension of the provider agreement and includes guidelines on doing business with Beacon, including policies and procedures for individual providers, affiliates, group practices, programs, and facilities. Together, the provider agreement, addenda, and this handbook outline the requirements and procedures applicable to participating providers in the Beacon Health Options network(s). This handbook replaces in its entirety the previous version.
Questions, comments, and suggestions regarding this handbook should be directed to Beacon at 800-397-1630.
Please click below to launch the Provider Handbook and the Provider Handbook Appendices. You will need Adobe® Reader to view the Handbook. If you do not have access to this software, you may download and install these applications on your computer.
- Appendix 1: Handbook Glossary
- Appendix 2: List of Forms & Reference Documents
- Medical Necessity Criteria
- Clinical Practice Guidelines
- Resource Documents
- Member Rights (English)
- Member Rights (Spanish)
- EDI Resource Document – E-Support Services for ProviderConnect and Electronic Claims
- Provider Summary Voucher Form Sample
- CMS 1500 Claim Form (Version 02/12)
- Tips for Completing the CMS 1500
- UB04 Claim Form
- Tips for Completing the UB04
- Payment Integrity: Provider Documentation Standards
- Clinical Department Hours of Operation
- Appendix 3: State/Government Program/Network Specific Provision and/or Supplements
- Appendix 4: Medicare Advantage Specific Provisions
- Appendix 4A: New York State Specific – Medicare Advantage/Medicare-Medicaid Dual Eligible Required Provisions (Fully Integrated Duals Advantage (FIDA))
- Appendix 4B: New York State Specific – NYS Medicaid Addendum
- Appendix 5: EAP Handbook
- Appendix 5A: MOS Handbook
Provider Handbook Updates
Beacon reserves the right to interpret and construe any terms or provisions in this Handbook and to amend it, at its sole discretion, at any time. To the extent that there is an inconsistency between the Handbook and the provider contract, Beacon reserves the right to interpret such inconsistency. Beacon’s interpretation shall be final and binding.