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


2019 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 EAP providers and to serving specific plans and/or states. These important resources are located on our provider website.

You can access the 2019 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.)

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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Noteworthy handbook updates

We updated a number of topics within our national handbook. Several to note:
  • Emphasized the requirement to use our online tools to enter and maintain the accuracy of your provider practice data as changes occur, in addition to a quarterly data accuracy review, under Network Provider Participation and Updating Practice Information (Section 2)
  • Clarified expectations for timely routine follow-up after initial evaluation and the requirement to notify us if you are unable to meet the standards or to accept new referrals in Member Access to Care (Section 3)
  • Updated the Telehealth Services Q&A for providers interested in offering this service (Section 3)
  • Outlined various criteria used to support clinical decisions in addition to our primary tool, the Magellan Care Guidelines (Section 3)
  • Revised data measurements descriptions and categories under HEDIS® and Performance Measurement (Section 3)
  • Added the deaf community as a disability group and culture under Cultural Competency (Section 4). See related article, How's your cultural competency?
  • Added information regarding federal requirements for maintaining state provider enrollment when serving Medicaid and/or CHIP members under Fraud, Waste, Abuse and Overpayment (Section 4)
  • Added time limit to file an appeal of a claims payment in Claims Filing Procedures and added specifics about our application of pre-payment coding edits to Electronic Claims Submissions (Section 5). See related article, Additional coding edits applied to claims
  • Clarified provider requirements to serve Medicare members under Medicare Beneficiaries (Section 6) and posted revision of Magellan’s Medicare Compliance Program policy (Appendix).

We did not make any changes to the Organizational and Facility Handbook Supplement for 2019.

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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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