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2021 national handbook and supplements 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.

Several revisions to note:

  • Updated Sub-Contracting Magellan’s Provider Agreements (Section 2) regarding the proper use of “incident-to” billing for services to Medicare Advantage plan members.
  • Added CMS Preclusion List information in Appealing Decisions that Affect Network Participation and Contract Termination (Section 2).
  • Clarified pre-authorization requirement for non-routine services with examples in Before Services Begin, and emphasized use of the online Psychological Testing request form (Section 3).
  • Added information about program time criteria in determining level of service in The Appropriate Level of Care (Section 3).
  • Updated information regarding the use of Telehealth Services during a natural disaster or national/regional crisis (Section 3).
  • Added a new topic called Recovery Support Navigation, a service provided by trained peer specialists (Section 3).
  • Explained where to obtain copies of current Medical Care Guidelines and Clinical Practice Guidelines (Section 3).
  • Added expectation of future online capabilities and encouraged use of provider portals often as a self-service tool for supporting your practice, Provider Website (Section 3).
  • Added supplemental measurements and clarification in HEDIS® and Performance Measurement (Section 4).
  • Added two new screening programs to Prevention/Screening (Section 4).
  • Updated Confidentiality (Section 4) by adding the requirement that consultants sign statements related to confidentiality of member information.
  • Updated expectations regarding complete and accurate medical records information according to standards, including details regarding the rendering provider and timely signing of records in Fraud, Waste, Abuse and Overpayment (Section 4).
  • Expressed intent to notify providers when additional payment options become available in Electronic Funds Transfer (Section 5).
  • Updated the following Appendix documents:
    • Prevention/Screening Programs additions and revisions
    • Policies: Medicaid Program Integrity and Medicare Advantage Compliance Program Policies, False Claims Laws and Whistleblower Protections Policy
    • Claims “Dos” and “Don’ts” revisions stress the importance of submitting complete and accurate provider data in order to pay a claim.

Changes to the Organizational and Facility Handbook Supplement for 2021 included:

  • Emphasized contacting Magellan for additional or other types of behavioral health benefits if needed prior to expiration of the current certification/authorization – watch for online contact capabilities; see Before Services Begin (Section 3).

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 benefit plans 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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