Claims Process Improvement Program

Project Overview

Beacon’s strategy for continuous improvement includes a transformative Claims Process Improvement (CPI) program. The program includes changes to several work streams designed to improve the provider experience:

Paper Claims

To ensure you are submitting paper claims to the right place, please verify the claims mailing address prior to sending paper claims. Many claims mailing addresses recently changed.

Important Documentation

Payment Integrity and Claims Analysis

Beacon has increased its focus on payment integrity and claims analysis to assure compliance with regulatory requirements and industry standards. Providers may receive requests for documentation to support and verify claims and payment accuracy. Beacon may adjust claims payments as a result of these payment accuracy reviews.

Important Documentation

EDI/Data Exchange

Beacon has created a single front-end gateway for all Beacon submitters to improve intake and processing of electronically submitted claims. In addition, we have implemented a process for validating and managing the exchange of data between Beacon and our trading partners.

Important Documentation

Technical questions about Electronic Claims Submission or Data Exchange?

Contact: EDI Helpdesk
Phone: 888-247-9311 from 8 a.m.–6 p.m. ET
E-mail: e-supportservices@beaconhealthoptions.com