Updated June 24, 2022 - heading "Prior Approval Requirements for Outpatient Specialized Therapies" was amended to "Prior Approval Requirements for Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers."
Effective July 15, 2022, behavioral health services provided by Children’s Developmental Services Agencies (CDSAs) and direct-enrolled providers in accordance with an individualized family service plan (IFSP) are required to resume the submission of prior approval (PA) requests to Beacon Health Options.
PA requests shall be submitted in accordance with the requirements outlined in clinical coverage policy 8J, Children’s Developmental Services Agencies:
Prior Approval Requirements for Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers
Refer to Section 5.0 of clinical coverage policies 8C, Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers for details on prior approval requirements for these services.
PA is required for medical approval only and must be obtained before rendering a service, product or procedure that requires PA. Obtaining PA does not:
- Guarantee payment
- Ensure beneficiary eligibility on the date of service; or
- Guarantee that a post-payment review that verifies a service medically necessary will not be conducted
Contact
Beacon Health Options, 888-510-1150