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We look forward to providing you with important national and regional information to help us work better together.
To ensure members can find you in provider directories, we ask you to routinely review and update your information.
Practitioners:
Visit
CAQH
, update your information, and attest that it is accurate.
Provider Groups and Facilities:
Visit the
provider portal
or call our National Provider Service Line at 800-397-1630 to share your individual provider information (not group information).
When
you update your information, it helps:
- Simplify referrals
- Expedite claims payments
- Ensure members can find you in provider directories
Thank you for all you do to help people live their lives to the fullest potential.
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New and Expanded Medicare Coverage of Opioid Use Disorder Treatment and Telehealth
The Centers for Medicare and Medicaid Services (CMS) is continuing to advance its goal to combat the opioid epidemic with new Medicare coverage beginning Jan. 1, 2020. This new coverage pays opioid treatment programs (OTPs) for delivering medication-assisted treatment (MAT) to people with Medicare suffering from opioid use disorder (OUD) and to add coverage for office-based OUD treatment.
The new HCPCS G-codes for the office-based OUD treatment for individual therapy, group therapy and counseling services included in HCPCS codes G2086, G2087, and G2088 may also be furnished via telehealth, as clinically appropriate. Effective July 1, 2019, these new telehealth codes add an individual’s home as a permissible originating telehealth services site for treatment of a substance use disorder or a co-occurring mental health disorder.
CMS has also encouraged Medicare Advantage Plans to offer more telehealth benefits than original Medicare, including adding benefits in non-rural areas and at the member’s home. Check your patients' benefits by calling the number on the back of their health plan ID cards.
The
SUPPORT Act
also opens up Medicare coverage to opioid treatment programs (OTPs) that are currently only covered by other payors. OTPs must enroll in the Medicare program in order to receive reimbursement for services provided to Medicare patients. OTPs fully-certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by a SAMHSA-approved accrediting body can start enrolling in the Medicare program so they can bill for services starting Jan. 1, 2020. See the
OTP Medicare Enrollment Fact Sheet
(PDF) for details.
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Important Quality Updates
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Free, Online, Self-Management Tools for Members
When members can self-identify risk factors or health issues early on, they can proactively take steps to improve their health. Offering self-management tools encourages members to monitor, track, and take charge of their own behavioral and/or physical health conditions.
Topics include (but are not limited to):
• Adult BMI Calculator
• Reducing High-Risk Drinking
• Increasing Physical Activity
• Integrated Care: Taking Charge of Your Health
• Do You Have a Nicotine Addiction?
• Are Your Weight Management Habits Healthy?
• Managing Stress in Your Life
• Identifying Common Emotional Concerns
• How Well Do You Bounce Back from Life’s Challenges?
Consider using these member-specific tools with Beacon members and/or recommending the website to members and their families, when appropriate.
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Reminder to Use Standardized Screening Tools with Members 13 Years and Older - Especially for Depression, Suicide, and Comorbid Issues
Beacon supports the early detection and treatment of depressive and comorbid disorders to promote optimal health for members 13 years and older.
A few helpful reminders:
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Happy Holidays from Beacon Health Options
As we approach the holiday season, Beacon wishes our providers, facilities, office staff, and group practices a safe holiday season and a very happy and prosperous new year.
We also want to express our appreciation to our provider partners for their participation and cooperation with Beacon’s policies, procedures, and quality activities. Although the season brings with it gratitude for services provided, we want to send a gentle reminder that Beacon employees are not permitted to accept or give gifts. Thank you for your understanding and cooperation with this policy.
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Value Options of California is now Beacon Health Options of California
We are pleased to inform you that ValueOptions of California, Inc. changed its name to Beacon Health Options of California, Inc. (“Beacon of California”). This change became effective Nov. 1, 2019. The name change establishes the relationship with our parent company, Beacon Health Options, Inc., while continuing to meet all our legal and regulatory requirements.
This is a name change only and will not impact how business is conducted on a daily basis. The terms of your provider contract and your existing reimbursement rates will not be changed. To continue your participating status as a network provider, no further action on your part is necessary.
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Texas Providers:
Procedure Code Change
for Non-Methadone Administration
Effective Nov. 1, 2019, the existing non-methadone administration procedure code H2010 will be directly replaced by procedure code H0033.
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American Society of Addiction Medicine
Updates Addiction Definition
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The American Society of Addiction Medicine recently updated its definition of addiction to better capture the complexity of this chronic disease. The new definition explains “more fully the complexity of this chronic disease with the intent of driving a bold and comprehensive national response that creates a future when addiction prevention, treatment, remission and recovery are accessible to all, and profoundly improve the health of all people.” According to the president and vice president of ASAM, Drs. Paul Earley and Yngvild Olsen, “Ultimately, public perception and public policy must reflect this nuanced understanding if our nation is to recover.”
Beacon has collaborated with University of new Mexico to offer ProjectECHO for opioid use disorder and is actively recruiting in Florida and New York. Providers that participate in this tele-mentoring program stay informed on the latest advancements in evidence-based, best practice care, medication-assisted treatment (MAT), and obtain ongoing access to patient resources.
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Medical Necessity Criteria
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Beacon Health Options transitioned to Change Healthcare’s InterQual
®
medical necessity criteria, on Sept. 21, 2019.
Did you miss one of our live webinars on the new medical necessity criteria? We recorded a training so that you can view the
60-minute training
at your convenience.
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Contact Us
Call our National Provider Service Line at 800-397-1630.
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