Members with the greatest risk of needing intensive behavioral health services, including inpatient care, are eligible for case management services. Case managers contact enrolled members, devise a treatment care plan, and coordinate with treatment provider s to assist with medication adherence and treatment plan compliance.
The program involves frequent telephonic counseling sessions with the case manager and face-to-face visits in the community, when possible, to keep the member out of the hospital. For electronic claims: Beacon encourages electronic claims submission through its secure ProviderConnect website, or through a clearinghouse. For paper claims:. Medicare members: Submit to EmblemHealth.
Montefiore members treated by Montefiore network: Submit to Montefiore. All other members: Submit to Beacon. Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan.
Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Switch to: members brokers employers. Sign in Contact Us Search. Navigation Open. Switch to:. Clinical Corner. Quality Improvement Find our Quality Improvement programs and resources here.
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Mental Health Checkups for Adolescents. Finding a Behavioral Health Provider. Use our online Find Care tool to find a mental health or substance abuse practitioner. Members may call EmblemHealth collaborates with Beacon Health Options, Health Homes, C-YES, and HCBS providers to gather information to support the evaluation of: Enrollee level of care Adequacy of service plans Provider qualifications Enrollee health and safety Financial accountability and compliance EmblemHealth uses aggregated data from its care management and claims systems to identify trends and opportunities for improving member care.
These strategies include: Provider access to rapid consultation from child and adolescent psychiatrists Provider access to education and training Provider access to referral and linkage support for child and adolescent patients Adult Behavioral Health Services EmblemHealth provides coverage of behavioral health services for Medicaid Managed Care MMC members 21 years of age or older who reside in New York City, and Nassau, Suffolk, and Westchester counties.
Preauthorization Requirements. Routine Outpatient Services — No Preauthorization Preauthorization is not required for routine outpatient services.
Non-Routine Behavioral Health Services — Preauthorization Required Preauthorization is always required for the following services: Inpatient behavioral health treatment Autism treatment Outpatient ECT electroconvulsive treatment Partial hospitalization Intensive outpatient treatment and partial hospitalization for mental health only Neuropsychological testing Psychological testing See Who to Contact for Preauthorization.
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Jan 3, · Effective January 1, , EmblemHealth’s behavioral health and substance use . Emblem Behavioral Health Services Program | Beacon Health Options. As a reminder, please ensure that you have completed your required Cultural Competency training. If you are a Practitioner, please visit CAQH, update your information, and attest that it is accurate. Provider Groups and Facilities may visit our provider portal or call our National Provider Service Line at to share your individual provider information. AdFree Health Insurance Health Insurance Quote. Contact Us Now And SaveTailored Health Insurance · Global Offices · Worldwide Cover · Free Quote and ComparisonInsurance coverage: Individual Insurance, Group Insurance, Family Insurance.