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Chapter 26: Behavioral Health Services
EmblemHealth looks to its medical and behavioral health providers to collaborate in caring for our members with mental health or substance abuse issues. We strongly encourage our primary care physicians (PCPs) to use screening tools to identify members who need more specialized care. If you have a member in need of mental health or substance abuse care, our partner Beacon Health Options (Beacon) administers our behavioral health services under two programs:
EmblemHealth Behavioral Management Program (BMP)
- Members of plans underwritten by GHI. See the:
EmblemHealth Behavioral Health Services Program (EBHSP)
- · Members of plans underwritten by HIP or HIPIC and our Bridge Program. See the:
- Although care for Medicaid and HARP members is coordinated through their Health Homes, the covered benefits are managed by Beacon and accessed through their provider network. Look for the section dedicated to Medicaid and HARP members later in this chapter.
Providers must verify member eligibility and benefits prior to rendering non-emergency services.
Refer to the Beacon Health Options Provider Handbook for full program requirements.
Under both programs, members access care through Beacon’s contracted providers. Beacon manages all behavioral health covered services including utilization management and case management. Montefiore performs utilization management functions for behavioral health services performed by their own providers and when the member has chosen a Montefiore PCP.
For EmblemHealth training presentations and other learning opportunities, see the Learning Online webpage.
For more behavioral health resources, see the Clinical Corner webpage.