Beacon Health Options, now Carelon Behavioral Health, may require prior authorization for a partial hospitalization program (PHP), depending on the member’s specific plan. Trinity Behavioral Health accepts Beacon-related behavioral-health benefits when the plan provides applicable coverage, but PHP eligibility, network status, medical necessity, and authorization must be verified.
Verify your Beacon/Carelon PHP benefits before admission.
Is PHP authorization the same for every Beacon/Carelon member?
No. Carelon states that authorization requirements and medical-necessity criteria can vary by health plan, contract, and member benefit coverage.
What can affect PHP approval?
Approval may depend on active eligibility, the underlying payer, clinical information supporting the requested level of care, network status, and plan-specific authorization rules.
Can PHP require continued review?
Yes. Some plans may require additional utilization review if treatment continues beyond an initial authorization period.
What should be verified?
- Active behavioral-health benefits
- Underlying health plan
- PHP coverage
- Network status
- Prior authorization
- Medical-necessity criteria
- Deductible, copay, and coinsurance
See Trinity’s PHP / day treatment program. For the Beacon/ValueOptions/Carelon relationship, see the carrier hub.
Verify Your Beacon/Carelon PHP Benefits
Authoritative resources
- Carelon Behavioral Health — Provider Portals
- Carelon Behavioral Health — Medical Necessity Criteria
- Carelon Behavioral Health — Member Benefits
Exact benefits vary by plan and should be verified directly. Authorization does not guarantee payment.