Magellan Healthcare
Provider Focus Newsletter
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2022 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.

Note the following revisions:

Section 1: Introduction

  • Updated About Magellan and Our Products to include our newly restructured care management program with a focus on discharge planning and personal member support through transitions along the continuum of care. 

Section 2: Behavioral Health Network

  • Clarified information on maintaining the accuracy of your administrative practice information in Network Provider Participation and in Updating Practice Information.
  • Added information about how to suppress your practice from provider directories in Updating Practice Information.
  • Explained that delivering some specialized clinical services may require additional contract documents in Contracting with Magellan.
  • Added information about individual provider responsibility to members in care when terminating your Magellan contract in Contract Termination.

Section 3: Role of the Provider and Magellan

  • Added information about online benefit certification in Before Services Begin.
  • Clarified the steps in Options to Request Reversal of an Adverse Benefit Certification.
  • Explained changes in our care management philosophy and expectations regarding transition of care in Continuity, Coordination, and Collaboration and Care Management.
  • Clarified our policy on Recovery Support Navigation services.
  • Added Magellan’s classification criteria for New Technologies.
  • Added information about online capabilities and encouraged use of provider portals often as a self-service tool for supporting your practice, Provider Website.

Section 4: Quality Partnership

  • Added expectations for your participation in A Commitment to Quality.
  • Explained your role in transition of care collaboration to meet performance standards in HEDIS® and Performance Measurement.
  • Clarified your responsibilities under Outcomes and Reimbursement.
  • Explained how you can provide suggestions, submit compliments, or file complaints online in Provider Input and participate in surveys in Provider Satisfaction Surveys.
  • Updated our policy and timeliness standards in Reporting Adverse Incidents.
  • Added inappropriate use of procedure code modifiers in Fraud, Waste, Abuse and Overpayment.

Section 5: Provider Reimbursement

  • Updated Claims Filing Procedures with how to obtain a member’s plan or claims information online.

Section 6: Medicare Beneficiaries

  • Added timeliness requirement for submission of claims for Medicare Advantage members in Medicare.

Appendices

  • Updated the following documents:
    • What You Need to Know About Credentialing and Contracting for Individuals
    • What You Need to Know About Credentialing and Contracting for Groups
    • Professional Provider Selection Criteria
    • Policies: Medicaid Program Integrity and Medicare Advantage Compliance Program Policies, False Claims Laws and Whistleblower Protections Policy          

Changes to the Organizational and Facility Handbook Supplement for 2022 included:

  • Updated Communication (Section 2) with information about self-service using the Magellan provider portal to maintain accurate information about your services, obtain certification and submit claims.
  • Clarified both provider and Magellan responsibilities in Value-Based Collaboration and Purchasing (Section 2).
  • Added information about our new care management model, including collaboration with staff and engaging members admitted to higher levels of care in Before Services Begin (Section 3) and in appendices C, D, E and F.
  • Updated information about Site Visits (Section 3) and Appendix A: Organization Site Review Preparation Guide.

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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