An Overview of

ProviderConnect

For Applied Behavior Analysis

(ABA) Providers

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ProviderConnect is an easy-to-use online application that

providers can use to complete everyday service requests.

Providers have the ability to access information 24 hours a day,

7 days a week.

Providers can use ProviderConnect to:

• Obtain information about member eligibility and benefit status

• Enter authorization/notification requests

• Search claims and authorizations

• View and print correspondence

• Access and update practice profiles

• Submit EDI claims and inquiries to the Beacon Customer Service Department

• Send messages to and receive messages from Beacon

• Attach documents

ABA and ProviderConnect

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Covered Codes for Authorizing ABA Assessment and Services

CPT Code Description Limitations Provider Assessment Services

0359T Comprehensive Assessment - Once per year

- Daily Max: 1 unit

- Initial Assessment ONLY

BCBA-D/BCBA/LABA X

0360T Assessment/Treatment Plan/*Re-Assessment--First 30 min - Daily Max: 1 unit BCBA-D/BCBA/LABA X X*

0361T Assessment/Treatment Plan/*Re-Assessment—Addt’l 30 min BCBA-D/BCBA/LABA X X*

Note: 0359T, 0360T/0361T may be authorized up to 8 hours for initial assessment

0360T/0361T may be authorized up to 3 hours for re-assessment*

0364T ABA Therapy– First 30 min - Daily Max: 1 unit BCBA-D/BCBA/LABA

BCaBA/RBT/BT

X

0365T ABA Therapy– Addt’l 30 min BCBA-D/BCBA/LABA

BCaBA/RBT/BT

X

0366T ABA Therapy in a group—First 30 min - Daily Max: 1 unit

- Group limited to 2-8

participants

BCBA-D/BCBA/LABA

BCaBA/RBT/BT

X

0367T ABA Therapy in a group --Addt’l 30 min - Group limited to 2-8

participants

BCBA-D/BCBA/LABA

BCaBA/RBT/BT

X

0368T Supervision/*Parent Training– First 30 min - Daily Max: 1 unit BCBA-D/BCBA/LABA/BCaBA* X

0369T Supervision/*Parent Training– Addt’l 30 min BCBA-D/BCBA/LABA/BCaBA* X

Note: 0368T/0369T used for supervision must be done with the child present by any of the following BCBA-D/BCBA/LABA

0368T/0369T used for parent training must be done with the child present by any of the following BCBA-D/BCBA/LABA/BCaBA*

0370T Parent Training with/without child present - Daily Max: 1 unit BCBA-D/BCBA/LABA/BCaBA X

0371T Group Parent training without child present - Daily Max: 1 unit

- Group limited to 2-8

participants

BCBA-D/BCBA/LABA X

0372T Social skills group - Daily Max: 1 unit

- Group limited to 2-8

participants

Licensed Master Level /BCBA-

D/BCBA/LABA/BCaBA

X

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Covered Codes for Authorizing ABA Services for Severe Behavior

Severe Behavior Codes

CPT Code Service Description Limitation Provider Assessment Services

0362T Assessment/Treatment Plan (Severe Behavior)– First 30 min

- Daily Max: 1 unit

Psychologist/BCBA-D/BCBA + 1 or more BCaBAs/RBTs/BTs

X

0363T Assessment/Treatment Plan (Severe Behavior) – Addt’l 30 min

Psychologist/BCBA-D/BCBA + 1 or more BCaBAs/RBTs/BTs

X

0373T ABA Therapy/ Supervision and/or parent training; child is present (Severe Behavior) – First 60 min

-Daily Max: 1 unit Psychologist/BCBA-D/BCBA + 2 or more BCaBAs/RBTs/BTs

X

0374T ABA Therapy/ Supervision and/or parent training; child is present (Severe Behavior) – Addt’l 30 min

Psychologist/BCBA-D/BCBA + 2 or more BCaBAs/RBTs/BTs

X

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ProviderConnect Advantages

Services

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• Verify member benefits and eligibility • View and print forms

• Request and view authorizations • Download and print authorization

letters

• Submit claims and view status • Access Provider Summary Vouchers

(PSV)

• Submit updates to provider

demographic information

• Submit credentialing applications

• Submit customer service inquiries • Access ProviderConnect message

center

Disclaimer: Please note that ProviderConnect may look different and have

different functionalities based on individual contract needs, therefore some

functions may not be available or may look different for your

specific contract.

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Benefits

Efficient processing allows for

quicker paymentReduces the need to call for

routine information

Decreases labor expenses,

paper files, and postage

Free and secure online

application, available 24/7

Less risk of human error or

mishandlingIntegrates with practice

management software

INCREASED CONVENIENCE, DECREASED ADMINISTRATIVE PROCESSES

Mac and Windows compatibleMobile device friendly

How to Access ProviderConnectSM

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How to Access ProviderConnect

How to Access ProviderConnect

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Go to www.BeaconHealthOptions.com, choose “Providers”

and “Beacon Health Options (formerly ValueOptions)

Providers”

Click on “ProviderConnect” on the right side of the screen and

choose the appropriate portal.

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Providers register online with ProviderConnectSM

• In order to register, you will use your Beacon ID Number

If you do not have a Beacon ID Number e-mail:

e-supportservices@beaconhealthoptions.com

After submitting your online registration form, you will receive a

ProviderConnectSM log-in with instructions so that you can

begin using ProviderConnectSM

ProviderConnectSM has three different types of user accounts

• Super User – Facility/Group Administrator

• Managed User – Staff account administered by Super User

• Standard User – Staff account administered by Beacon Health Options

ProviderConnectSM Registration

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ProviderConnectSM Registration Forms

Complete the Provider online services registration by completing all of the

required fields. Please note that claims are managed directly by the plan, so

you do not have to check off Claims Submission to be able to submit claims

through ProviderConnectSM

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Enter your User ID and password and then click the “Log In”

button

Logging into ProviderConnectSM

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Logging into ProviderConnectSM

• Read the ProviderConnect Use Agreement and click “I Agree” to

continue

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Logging into ProviderConnectSM

Verifying Participant Eligibility

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Checking Participant Eligibility

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Checking Participant Eligibility

• Enter the participant’s information that you are checking eligibility for and

click the “Search” button

Authorizations

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ABA services through Beacon require prior authorization as

requested within ProviderConnectSM

The authorization will contain the approved date range,

procedure codes, and authorized units of service for that

participant.

Authorizing ABA Services

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Entering an Authorization Request

Disclaimer

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• Read the Disclaimer and click the “Next” button

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Enter the participants information that you are requesting

authorization for

Entering an Authorization Request

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Ensure correct participant is identified

Click “Next”

Entering Authorization Request

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Release of Information

Service Address

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Service Location

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Selection of Assessment or Services

Level of Service: Outpatient Community Based

Type of Service: Mental Health

Level of Care: Outpatient

Type of Care

• Select ABA Assessment for initial assessment requests

• Select ABA Services for treatment requests

ABA ASSESSMENT REQUEST

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ABA Assessment

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ABA Assessment

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ABA Assessment Behavioral Diagnosis

ABA Assessment Medical Diagnosis

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ABA Assessment Social Elements Impacting Diagnosis

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ABA Assessment Requested Services

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ABA Assessment Requested Services

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ABA Assessment Results

ABA SERVICES REQUEST

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To enter a request for ABA treatment, complete the following

steps

1. Select Level of Service: Outpatient/Community Based; Type of Service:

Mental Health; Level of Care: Outpatient; and Type of Care: ABA

Services

Selection of ABA Services

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ABA Services

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ABA Services

ABA Services Behavioral Diagnosis

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ABA ServicesMedical Diagnosis

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ABA ServicesSocial Elements Impacting Diagnosis

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ABA Services

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ABA ServicesCurrent Impairments

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ABA ServicesCurrent Skills Impairments

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ABA ServicesProgress

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ABA Services Requested Services

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ABA Services Requested Services

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ABA ServicesABA Report

Concurrent Requests

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Concurrent Requests

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Concurrent Requests

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Concurrent Requests Behavioral Diagnosis

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Concurrent Requests Medical Diagnosis

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Concurrent Requests Social Elements Impacting Diagnosis

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Concurrent Requests

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Concurrent Requests Current Impairments

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Concurrent Requests –Current Skill Impairments

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Concurrent Requests Progress

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Concurrent Requests –Upload Treatment Plan

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Concurrent Requests Requested Services

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Concurrent Requests Requested Services

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Concurrent RequestsABA Report

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There is an option to click “Save Request as Draft” in case additional

information or approval is needed before submitting to Beacon

Indicate the authorized user if another department or supervisor

needs to review the request

Keep in mind, saved drafts are not automatically submitted to

Beacon – be sure to go back, complete the draft, and submit in a

timely fashion

NOTE: Attach all documents prior to submission as attachments do

not save on drafts

ProviderConnect TIP

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Locate “Save as Draft”

Review an Authorization

Review an Authorization

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Search Authorizations

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Authorization letter can be accessed by clicking the paper icon

Hyperlink shows additional details specific to the participant

and authorization

Authorization Search Results

Authorization Search Results

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Providers can submit an inquiry to Beacon utilizing the “Send

Inquiry” function

Authorization Search Results

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Contact Information

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Contact Information

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National Provider Service Line

Monday through Friday

8 a.m. – 8 p.m. ET

Phone: 800-397-1630

ProviderConnect Technical Questions

Monday through Friday

8 a.m. – 6 p.m. ET

Phone: 888-247-9311

Email: e-supportservices@beaconhealthoptions.com

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Thank you