Physicians/Specialists
Facilities/Hospitals
Ancillary
Publication Date: 
2019-11-21

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) wants to make sure our contracted providers have access to Beacon Health Options' (Beacon) Medical Necessity Criteria (MNC), also known as clinical criteria.

Key Points

  • Beacon's MNC are reviewed and updated at least once each year to make sure they reflect the latest developments in serving individuals with behavioral health diagnoses.
  • Beacon recently transitioned to InterQual®, an evidence-based clinical decision support solution to help payers, providers, and government agencies make clinically-appropriate medical utilization decisions for mental health services.
    • To register for access to InterQual's MNC for mental health, please click here.
  • In addition to InterQual, Beacon still uses the American Society of Addiction Medicine (ASAM) criteria for substance use treatment.
    • To access ASAM's medical necessity section of their provider handbook, please click here and:
      • Click "Providers" from the dropdown menu in the upper-right corner
      • Click "Beacon Health Options Providers"
      • Click "Provider Handbook"
      • Scroll down to "Medical Necessity Criteria" under "Appendix 2: List of Forms & Reference Documents"
    • To access ASAM's Introduction to the ASAM Criteria for Patients and Families, please click here.