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Important Announcements for Beacon Health Plan Providers - May 2017​

Tuesday, May 2, 2017   (0 Comments)
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Important Announcements for
Beacon Health Plan Providers - May 2017
Jennifer Warkentin, Ph.D., Director of Professional Affairs for MPA
Clare O'Callaghan, R.N., C.S., Ed.D., Chair of Beacon MNS/MPA Joint Advocacy Committee

MPA and the Massachusetts Neuropsychological Society hold regular meetings with Beacon to advocate for positive changes, voice members’ concerns, educate the insurers about research and innovative evidence-based assessments, treatments, and standards of care, learn about initiatives and issues the health plans are working on, and address on-going issues with authorization and payments of neuropsychological and psychological assessments. Following is a summary of information we have gathered and responses to recent provider complaints:

Clawbacks and same-day service coverage. All MCOs must work with the National Correct Coding Initiative (NCCI) to implement CMS coding requirements, some of which are at odds with MassHealth requirements.  Beacon is still in the process of negotiating the details with NCCI, but one of the areas they are looking at is same-day coverage.  As soon as we have more details on the results of those negotiations, we’ll inform our members.

    • Coverage of consultation codes.  The recent clawbacks for same-day services with consultation codes occurred because of the NCCI requirements, and have been rectified.  MassHealth requires unlimited use of consultation codes (90882, 99887) so that will continue to be an options even though it contradicts the NCCI rules.  Beacon canceled clawbacks for same-day services involving a consultation code, and all affected providers should have received a refund by now.  If you have not, please contact Jennifer Warkentin at  Beacon also wants to remind providers to include all the necessary information in their documentation of consultations- you can review the requirements MPA sent out last summer here.
    • Billing an intake and therapy in the same day.  Beacon historically has approved the use of 90791 and a therapy code (such as family therapy).  This is not consistent with NCCI protocol so it is unlikely that it will continue to be approved.

Credentialing.  Beacon noted that they were aware of the problems providers have experienced in the credentialing process and have amended their procedures.  Completed CAQH profiles should now meet all their criteria.  Providers who are not on CAQH must fill out a separate application.

    • Necessary documentation. A completed CAQH should be sufficient, and Beacon has an application for providers not on CAQH.  Beacon does not consider a CAQH application complete until it includes a copy of the provider’s license and a cover page from the provider’s liability insurance policy. 
    • Providers in independent practice.  Providers who are in independent practice must also submit a disclosure of ownership form, found here.  Failure to include this form is a common reason applications are denied.
    • Re-credentialing.  CAQH applications must be re-attested every 120 days.  In addition, Beacon requires re-credentialing every 2 years for providers. 
    • Denials.  All incomplete applications are now returned to the provider with an explanation of what’s missing.  If the revised application is not returned within 15 days, the request is refused and the provider must start the process again. 
    • Single case agreements.  There is currently a lag between approval of a single case agreement and updating data on credentialing for a single case agreement.  Until all the data has been updated, providers cannot get paid for their services, but providers can get retroactively paid back to the date that the credentialing was completed.

Request for assessment records.  Beacon clarified that if a provider’s use of coding falls outside the normal expectations, the provider is asked to send in the chart.  They are specifically requesting the following information about each testing session: date, time started, time finished, number of units, and a brief description of what was done in the session.  They do not want providers to submit final testing reports or data.  They need documentation to support the amount of time that the provider is billing for.

Provider relations.  Beacon reported that they are aware of provider complaints about long wait times and structural changes to the provider relations department will be coming soon.  In the meantime, providers can also email the department at

Confusion around when different plans renew.  Beacon clarified that all MassHealth plans renew by calendar year (January 1), GIC renews by Commonwealth fiscal year (July 1), and Commercial products (including connector products) renew by plan year (which varies based on employer).  Providers can use eServices to find current eligibility and coverage.

Submission of prior authorization forms.  Beacon encourages providers to use eServices to submit their requests.  Handwritten forms continue to be a significant problem due to the frequency of writing not being legible. 

CANS exception in neuropsychological assessment.  For MassHealth, all intake evaluations (90791) done with clients under the age of 21 require a CANS.  When billing for 1 unit of 90791 as part of a pre-assessment (prior to psychological or neuropsychological testing), clinicians should note that the assessment is part of a “pre-test” so that the claim will pay.  The CANS will still be required, but the requirement will essentially be delayed until testing is complete.

We will continue to meet with Beacon quarterly to raise your concerns and assist in improving all psychological services for Beacon patients.

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