Clinical Criteria

  1. INTRODUCTION
    • 1.10 Clinical Philosophy
    • 1.20 Determining Medical Necessity
    • 1.30 Determining the Appropriate Level of Care
    • 1.40 Evaluating Necessity for Continued Care
    • 1.50 Discharge Criteria
    • 1.60 Clinical Criteria Development
    • 1.70 Account Specific Variations
  2. MENTAL HEALTH FACILITIES AND PROGRAMS
  3. MENTAL HEALTH FACILITIES AND PROGRAMS
  4. SUBSTANCE USE PROGRAMS: ADULT AND ADOLESCENT
    Beacon Health Options uses the American Society of Addiction Medicine, Inc. (ASAM) Patient Placement Criteria to make authorization determinations for Substance Use Care. For more information about a determination for Substance Use care, please read Introduction to The ASAM Criteria for Patients and Families.

  5. RETIRED / ARCHIVED CRITERIA
    • 4.701 Substance Use Laboratory Testing for Drug and Alcohol Use (Retired – reference NMNC 6.605.01)
    • 2.605 Biofeedback (Retired – reference NMNC 5.503.01)
    • 2.302 Group Homes (Retired – reference NMNC 2.203.01)
    • 3.302 Group Home (Retired – reference NMNC 2.203.01)
    • 2.101 Crisis Response Team/Mobile Crisis Team (Retired – reference NMNC 4.401.0)
    • 2.102 23-Hour Crisis Observation, Evaluation, Holding, and Stabilization (Retired – reference NMNC 1.102.0)
    • 2.103 Crisis Residential/Crisis Stabilization Unit (Retired – reference NMNC 2.201.0)
    • 2.1101 Psychological/Neuropsychological Testing – Adult (Retired – reference NMNC 5.502.0)
    • 2.201 Acute Inpatient Mental Health (Retired – reference NMNC 1.101.0)
    • 2.301 Residential Treatment Center – RTC (Retired – reference NMNC 2.202.0)
    • 2.401 Partial Hospitalization – Adult (Retired – reference NMNC 3.301.0)
    • 2.402 Day Treatment – Adult (Retired – reference NMNC 3.303.0)
    • 2.403 Intensive Outpatient Programs – Adult (Retired – reference NMNC 3.302.0)
    • 2.503 Assertive Community Treatment (Retired)
    • 2.601 Outpatient Services – Adult (Retired – reference NMNC 5.501.0)
    • 2.602 Therapeutic Stabilization (Retired)
    • 3.101 Crisis Response Team/Mobile Crisis Team – Adult (Retired – reference NMNC 4.401.0)
    • 3.102 23-Hour Crisis Observation, Evaluation, Holding, and Stabilization – Adult (Retired – reference NMNC 1.102.0)
    • 3.103 Crisis Residential/Crisis Stabilization Unit – Child/Adolescent (Retired – reference NMNC 2.201.0)
    • 3.1101 Psychological/Neuropsychological Testing (Retired – reference NMNC 5.502.0)
    • 3.201 Acute Inpatient Mental Health – Child/Adolescent (Retired – reference NMNC 1.101.0)
    • 3.301 Residential Treatment Center (RTC) – Child/Adolescent (Retired – reference NMNC 2.202.0)
    • 3.401 Partial Hospitalization – Child/Adolescent (Retired – reference NMNC 3.301.0)
    • 3.402 Extended Day Treatment – Child/Adolescent (Retired – reference NMNC 3.303.0)
    • 3.403 Intensive Outpatient Programs – Child/Adolescent (Retired – reference NMNC 3.302.0)
    • 3.503 Assertive Community Treatment (Retired)
    • 3.701 Outpatient Services – Child/Adolescent (Retired – reference NMNC 5.501.0)
    • 3.702 Therapeutic Stabilization (Retired)
    • 3.704 Psychological Testing
      • 3.704.2 Sample Psychological Testing Evaluation Form (Retired)
      • 3.704.3 List of Psychological Tests (Retired)
    • 3.705 Applied Behavior Analysis (ABA) – Child/Adolescent (Retired – reference NMNC 6.604.0)
    • CHILD WELFARE CRITERIA (Retired)
    • 6.101 Psychiatric Short-Term Disability (STD) Benefit Determinations (Retired)
    • 6.102 Psychiatric Long-Term Disability (LTD) Benefit Determinations (Retired)
    • 7.101 Electroconvulsive Therapy (ECT) (Retired – reference NMNC 6.601.0)
    • 7.102 Repetitive Transcranial Magnetic Stimulation (rTMS) (Retired – reference NMNC 6.602.0)
    • 8.201 Acute Inpatient Eating Disorder – Adult and Adolescent (Retired – reference NMNC 1.101.0)
    • 8.301 Residential Treatment Services (RTS) Eating Disorders – Adult and Adolescent (Retired – reference NMNC 2.202.0)
    • 8.401 Partial Hospitalization Program Eating Disorders – Adult and Adolescent (Retired – reference NMNC 3.301.0)
  6. DISABILITY CRITERIA
  7. OTHER CRITERIA
  8. EATING DISORDER CRITERIA: ADULT AND ADOLESCENT
  9. HORIZON: ADULT AND ADOLESCENT
  10. MEDICARE PSYCHIATRIC FACILITY SERVICES
  11. LEVEL OF CARE – STATE SPECIFIC