Magellan Healthcare
Provider Focus Newsletter
News & information for Magellan network providers

columns : Network Notes

2018 national handbook and supplements update now online

We’ve recently updated the Magellan National Provider Handbook and several of the handbook supplements that pertain to organizations, to EAP providers, and to serving specific plans and/or states. These important resources are located on our provider website.

You can access the 2018 National Provider Handbook and supplements at – under News & Publications, choose Handbooks. (You can find the supplements on the State-, Plan- and EAP-Specific Information page.)

Noteworthy handbook updates

We updated a number of topics within our national handbook. Several to note:
  • Modified Network Provider Participation (Section 2) with new information about available online tools and instructions to set up and maintain the accuracy of your provider profile and financial record
  • Added new types of electronic information that support referrals to your practice and our response to member reports of inaccurate data under Updating Practice Information (Section 2); plus a requirement to use our online tools to enter and maintain the accuracy of your provider practice data under Provider Website (Section 4)
  • Updated information regarding the use of member self-assessment surveys and screening tools, and that certain non-routine outpatient services may require authorization in Before Services Begin (Section 3)
  • Clarified expectations for timely routine follow-up after initial evaluation in Member Access to Care (Section 3)
  • Explained when Magellan Care Guidelines (previously Medical Necessity Criteria) (Section 3) will be updated in 2018, and a reminder to assess cognitive functioning in older adults
  • Added to treatments remaining investigational in New Technologies (Section 3)
  • Clarified the measurement of clinical outcomes: expectations, tools and resource information in Outcomes 360 (Section 4)
  • Added instructions regarding Adverse Incident Reporting (Section 4) when incidents involve our members
  • Updated Medicare compliance requirements related to training and record retention Medicare Beneficiaries (Section 5) and posted revision of Magellan’s Medicare Compliance Program policy (Appendix).
We also updated the Organizational and Facility Handbook Supplement for 2018. Two to note:
  • Clarified our policy regarding potential for increased referrals using reimbursement models that align incentives and reimbursement with value-based care in Value-Based Collaboration and Purchasing (Section 2)
  • Confirmed credentialing expectations for organizations and associated individual practitioners for eligibility to treat our members in What You Need to Know About Organization Credentialing and Contracting (Appendix B).
In accordance with your agreement(s) with Magellan and/or its affiliated companies, you should adhere to the policies and procedures outlined in the national handbook and any supplements that apply to states in which you practice or lines of business for which you are eligible to see members. 

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About Provider Focus

Welcome to Provider Focus, our award-winning e-newsletter for network providers! Here you’ll find articles and information to keep you up-to-date on news and topics relevant to serving Magellan members, including a section for regional- and plan-specific news. Check back as a new issue is released each quarter.

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