Quick Links
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.
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. 
Regulatory News
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.
Important Quality Updates
Reminder to Review the Clinical Practice Guideline and Measurement Tool

As noted in the May 2019 issue, Beacon reviews and endorses clinical practice guidelines to support providers in making evidence-based care treatment decisions on various topics. The most up-to-date, endorsed, clinical practice guidelines are posted on the Beacon website

Additionally, each year, Beacon measures providers' adherence to at least three (3) Clinical Practice Resources. Beacon has chosen the following two adult-focused and one child-focused Clinical Practice Resources for 2019 national measurement, unless otherwise required by contract: 

Clinical Practice Resources
  1. National Action Alliance For Suicide Prevention: Recommended Standard Care for People with Suicide Risk: Making Health Care Suicide Safe (PDF)
  2. American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition 
  3. American Academy of Child and Adolescent Psychiatry Practice Parameter for the Assessment and Treatment of Children and Adolescents with Reactive Attachment Disorder and Disinhibited Social Engagement Disorder (PDF) 

Beacon will review a portion of its members’ medical records using the tool posted on the Beacon website . Questions have been developed from the resources, and baseline data will be collected in 2019. 

Please take time this month to review the clinical practice guidelines and measurement tool to ensure your standards of practice align.
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. 

Beacon offers member-specific self-management tools and educational content. Members can find them on our Achieve Solutions platform. as well as on the Beacon Health Options website under Member Health Tools .

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. 
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:
Policy Reminder
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.
Regional News
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.
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.

You may read more about this change in a PDF document posted on the Texas Medicaid Healthcare Partnership website .
American Society of Addiction Medicine
Updates Addiction Definition
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.

To learn more about Beacon, Project ECHO, or to sign up for a training session email us at: [email protected]
Medical Necessity Criteria
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.