value options mental health claims form submission address

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value options mental health claims form submission address

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Reviewed 10/1/2013, 10/1/2014, 3/31/2016. Revised 10/1/2013, … Address” form
available at by fax or email to: Beacon Health Options,
Inc. … For providers who are unable to submit a claim electronically, the claim.

Claims Procedures (PDF) – ValueOptions

Reviewed 10/1/2013, 10/1/2014, 3/31/2016 … To electronically submit claims,
ValueOptions of California participating … The provider must also submit the
Intermediary Authorization form to be …. Conditional This field contains the
address to ….. Religious Non-medical Health Care Institutions (RNHCI) –
Hospital Inpatient.

January 2016 – ValueOptions

Jan 31, 2016 … Beacon, the nation's premier behavioral health management company, asked
New Yorkers … health awareness their 2016 New Year's resolution. A 23-story
digital ….. reporting through online ProviderConnect submission or paper form. In
order to …. on both the claim and the claims' address. The payer ID.

AVAILABILITY The following criteria applies to all … – ValueOptions

Credentialing Criteria Checklist – Revised 02.24.2016 … Foreign medical school
graduates must submit an Educational Commission for Foreign … Before
completing the Practitioner Data Form for Beacon Health Options, Inc. (Beacon),
formerly … Must possess a Master's degree in mental health counseling or allied
mental …

TRICARE Provider Handbook 2015 – Humana Military

“TRICARE” is a registered trademark of the Defense Health Agency. (DHA). All
rights ….. Claims using Medicare and TRICARE . …. ValueOptions® Federal
Services is Humana Military's mental health care contractor in the TRICARE
South Region. ….. All providers must submit certification forms to PGBA to
become a.

837 Professional/CMS-1500 Claim Form –

Apr 21, 2016 … Address any comments concerning the contents of this manual to: … its people. ©
2016 Hewlett-Packard Development Company, LP. …. 2.1.3 Office of Mental
Health and Substance Abuse Services . …. 2.5 Invoicing Options . … 2.7 Time
Limits for Claim Submission . ….. 4.3.2 Value Added Networks (VAN) .

Download Chapter PDF – EmblemHealth

Last Updated: 04/29/2016. 525 … EmblemHealth has engaged ValueOptions® to
administer behavioral health services for most of its members under two ….
Provider claims should be submitted to EmblemHealth, except those for … If
submitting on paper, outpatient professional services must be billed on a CMS-
1500 form.

TRICARE® – Health Net Federal Services

Apr 1, 2015 … March 31, 2016, the information in this handbook is current. … We continually
strive to improve our materials and value your input as ….. TRICARE Prime
Coverage Options . …. Non-Covered Behavioral Health Care Services . …. Claims
Submission Addresses . ….. 1500 Claim Form Place of Service Codes .

EmblemHealth Provider Manual

Jul 1, 2013 … EmblemHealth and its companies Group Health Incorporated (GHI), HIP …. Paper
claims (CMS 1500 forms) may be sent to the addresses indicated, … claims. HIP:
55247. GHI HMO: 25531. Vendor or direct submission …. Emblem Behavioral
Health Services Program … ValueOptions Provider Connect.

Download Chapter PDF – EmblemHealth

Pathways For Electronic Claim Submission To EmblemHealth … ADOLESCENT
…. Paper claims (CMS 1500 forms) may be sent to the … information when
different from the Billing Provider Address. ….. diagnosis is exempt, enter a value
of "1.".

Aetna Better Health PowerPoint template with photos – Aetna Medicaid

Feb 1, 2016 … value. Trust and respect each other. Be open to all voices and ideas … As of May
1, 2016, Medicaid ID/Aetna Better Health of Kentucky ID will be required and the
…. February 1, 2016. • All claims should be submitted on the most current claim
forms. The new address is for behavioral and medical claims. 29 …

Provider Manual – ( for

April 2016 ….. The Connecticut Behavioral Health Partnership (CT BHP) began
January 1, 2006, …. For information on submitting electronic and web claims to
HP, call HP at the … Once Medicaid enrollment is complete and Beacon Health
Options is notified of … assistance with completing the Provider Data Verification

Provider Manual January 2016 – Neighborhood Health Plan of …

January 2016 … How to Submit Claims Electronically to Neighborhood ….
Changes to Billing Address/Tax Identification Number Notification Form.
Behavioral Health Request Form. •. Primary Care Provider Behavioral Health
Communications Form … Options UNITY, a Medicaid managed care program for
Medicaid Only and … – TRO-South

TRICARE Prime Remote Determination of Enrollment Eligibility, Submit this form
if you … Only service members or unit commanders can submit this form.

JazzUP ASO (PPO 250-90/70 Value) (1/09) –

High Option Supplement to Medicare … Effective Date: January 1, 2016. A …
health care needs, you should read carefully those sections of the booklet that
apply to … contact the Claims Administrator at the address or telephone number
…. Submitting a Claim Form . …. Residential Care Program for Mental Health

Medicaid Managed Care Handbook –

The Texas Medicaid & Healthcare Partnership (TMHP) is the claims … April 2016
….. STAR Health Mental Health Rehabilitation Mental Health Claims Submissions
. …. Value-added services that an individual MCO or dental plan elects to cover.
…. TMHP, the provider must also submit Form 7.2, “Texas Medicaid Refund …

Medicare Billing: 837I and Form CMS-1450 [PDF, 823KB]

providers to transmit health care claims electronically. The Form. CMS-1450, also
known … Outpatient Rehabilitation Facilities (CORFs), Community Mental Health
… Fee schedules, relafive value units, conversion factors and/or related … Other
chapters offer claims submission information specific to an institutional provider.

CHAMPVA Guide – US Department of Veterans Affairs

To obtain authorization for mental health and substance abuse services ….. When
you use any of these options, make sure you provide your name and address. ….
need to submit the itemized bill, CHAMPVA Claim Form and the EOB from the
primary …. name and quantity of the drug, the drug's retail value and the amount

2016 Active Employee Benefits Handbook – Wayne State University

grandfathered health plan and what might cause a plan to change from … are
answered by the HR Employee Resource Center or by sending an email to …
enrollment forms are located on our Web site at ….. Claim
F. There ar. Network. 2016 Benefits Handbook. 2016 Plan Year ….. Value Options

New York – Oscar | Provider Resources and Manuals

CMS 1500 Claim Form. CVS Formulary Exception Prior Authorization Form …
Oscar New York Provider Manual Version 3.0 – Updated as of 04/15/2016. 1 …
Submit claims. Claim type. Network. Address. Medical Services. MagnaCare …..
Authorizations for the mental health benefit are done by ValueOptions / Beacon