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  • Credentialing > Behavoiral Health Credentialing

    To see the credentialing requirements for our Behavioral Health Network, please see Beacon Health Option’s provider manual. The following provider types should contact Beacon Health Options to address participation:

    • Caregiver/Family Supports and Services – behavioral health primary diagnosis
    • Community Self-Advocacy Training and Support – behavioral health primary diagnosis
    • Habilitation – behavioral health primary diagnosis
    • HCBS/SPA services – behavioral health primary diagnosis
    • NYS-designated providers of Children’s Specialty Services – behavioral health primary diagnosis
    • NYS-determined Essential Community Behavioral Health providers for children – behavioral health primary diagnosis
    • OMH and OASAS licensed or certified providers
    • Psychologists
    • Prevocational Services
    • Psychiatrists
    • Respite – behavioral health primary diagnosis
    • School-based mental health clinics
    • Social Workers
    • Supported Employment

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    Glossary terms found on this page:

    Conditions that affect thinking and the ability to figure things out that affect perception, mood and behavior.

    An itemized statement of health care services and their costs provided by a hospital, physician's office or other health care facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.

    An organization comprised of individual physicians or physicians in group practices that contracts with the managed care organization on behalf of its member physicians to provide health care services. Also called an Independent Practice Association.

    A permit (or equivalent) to practice medicine or a health profession that is: 1) issued by any state or jurisdiction in the United States and 2) required for the performance of job functions.

    Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

    Conditions that affect thinking and the ability to figure things out that affect perception, mood and behavior.

    The group of physicians, hospital, and other medical care providers that a specific plan has contracted with to deliver medical services to its members.

    A health plan that offers benefits in-network and out-of-network. In-network services are available to enrollees at lower out-of-pocket cost than the services of non-network providers. In addition, PPO enrollees may self-refer to any network provider at any time. Also called a Preferred Provider Organization.

    A medical practitioner or covered facility recognized by EmblemHealth for reimbursement purposes. A provider may be any of the following, subject to the conditions listed in this paragraph:

    • Doctor of medicine
    • Doctor of osteopathy
    • Dentist
    • Chiropractor
    • Doctor of podiatric medicine
    • Physical therapist
    • Nurse midwife
    • Certified and registered psychologist
    • Certified and qualified social worker
    • Optometrist
    • Nurse anesthetist
    • Speech-language pathologist
    • Audiologist
    • Clinical laboratory
    • Screening center
    • General hospital
    • Any other type of practitioner or facility specifically listed in the member's Certificate of Insurance as a practitioner or facility recognized by EmblemHealth for reimbursement purposes

    A provider must be licensed or certified to render the covered service. The covered service must be within the scope of the Provider's license or certification.

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