Beacon health strategies 90 day waiver form 2026

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  1. Click ‘Get Form’ to open the beacon health strategies 90 day waiver form in the editor.
  2. Begin by filling out the Demographic Information section. Enter the Provider Name, Beacon Provider ID, Member Name, Member ID, Contact Person, and Telephone Number accurately.
  3. In the Reason(s) For Waiver section, check all applicable reasons for requesting a waiver. Ensure you attach any required documentation such as a copy of the claim or EOB if necessary.
  4. Review your entries for accuracy. In the certification statement, confirm that the claim for services is true and correct before signing.
  5. Sign and date the form in the designated areas to complete your submission.

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To discuss outpatient treatment options covered by Beacon Health Options insurance in Los Angeles, California, please contact us for a complimentary verification of benefits. Its helpful to have the insurance card and any relevant information readily available to expedite the process.
Anthem, Inc. completed its acquisition of Beacon Health Options (Beacon), a large behavioral health organization that serves more than 36 million people across the country. Beacon will operate as a wholly owned subsidiary of Anthem. Empire BlueCross BlueShield HealthPlus is a wholly owned subsidiary of Anthem.
To submit EDI claims through an intermediary, contact the intermediary for assistance. If using Office Ally, use Beacons Office Ally Payer ID 43324: CCAH Plan ID 108.
Beacon Health Strategies is a Beacon Health Options company. Today we are Carelon Behavioral Health. We are working on updating all documents, but some historic references to Beacon may remain. Our name may be new, but our commitment to you remains the same.

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