: Commercial Health Plans in DC, DE, FL, IL, MD, MI, NC, NJ, OK, PA, TX, VA
Check your numbers
Does your schedule accommodate members' access to behavioral health services within a timeframe that reflects the clinical urgency of the situation?
Per your agreement with Magellan, it should.
When we looked at the data on provider accessibility (for the Magellan care center managing plans in the above-listed states), it showed that provider appointments are not consistently available to members within timeliness standards. Be watching for results from the 2018 Provider Accessibility Survey in the next edition of Provider Focus.
In the meantime, how would you assess your adherence to these standards?
- Provide access to services 24 hours a day, seven days a week.
- Inform members of how to proceed, should they need services after business hours.
- Provide coverage for your practice when you are not available, including, but not limited to, an answering service with emergency contact information.
- Respond to telephone messages in a timely manner.
- Provide immediate emergency services when necessary to evaluate or stabilize a potentially life-threatening situation.
- Provide services within six hours of referral from Magellan in an emergent situation that is not life-threatening.
- Provide services within 48 hours of referral from Magellan in an urgent clinical situation or within 24 hours if required by a specific customer benefit plan.
- Provide services within 10 business days of referral from Magellan for routine clinical situations.
- Provide routine follow-up services within 30 days of an initial evaluation (non-prescribers), or 90 days of an initial evaluation (prescribers).*
- Provide services within seven days of a member’s discharge after an inpatient stay.
- For continuing care, continually assess the urgency of member situations and provide services within the timeframe that meets the clinical urgency.
- Complete Magellan’s appointment availability surveys to assist us in evaluating whether our networks meet access expectations and standards for all required levels of care.
Thank you for your help meeting the behavioral healthcare needs of Magellan members.
*The updated requirements for routine follow-up services are included in the 2019 Magellan National Provider Handbook (PDF).