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Beacon provides clinical staff coverage 24 hours/day, 7 days/week, 365 days/year
to respond to all member and provider calls, including emergent, urgent and routine
All of Beacon’s UM decisions are based on Beacon’s Level of Care criteria (medical
necessity). Financial incentives based on the number of adverse determinations or
denial of payments by any individual involved in UM decision making is prohibited.
If you have questions, suspicions, concerns, or would like to report potential fraud and abuse involving a Beacon Health Strategies provider or member, please call us at 781.994.7500 and ask to speak with our compliance officer. You can also email us at email@example.com. You do not need to identify yourself. You can send an anonymous letter to us at:
Beacon Health Strategies
Attn: Fraud and Abuse
200 State Street, Suite 302
Boston, MA 02109
Informing Members of Their Rights
In addition to providing a posted statement of
Member rights, Providers are also required to:
- Distribute and review a written copy Member Rights and Responsibilities at the initiation
of every new treatment episode and include in the Member’s medical record documentation
of this review.
- Inform Members that Beacon does not restrict the ability of contracted Providers
to communicate openly with Members regarding all treatment options available
to them including medication treatment regardless of benefit coverage limitations.
- Inform Members that Beacon does not offer any financial incentives to its contracted
Provider community for limiting, denying, or not delivering medically necessary
treatment to members.
- Inform Members that clinicians working at Beacon do not receive any financial incentives
to limit or deny any medically necessary care.