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


Medical necessity criteria updates to occur in July; include Milliman Care Guidelines

As you may know, Magellan uses Milliman Care Guidelines – in addition to our proprietary clinical criteria – as the primary decision support tools for our Utilization Management Program for commercial health plans. Collectively, they are known as the Magellan Care Guidelines.

The updated criteria set will become effective July 1, 2018. Stay tuned to our provider website,, for its release.

Note that criteria for some levels of care, plans and states differ. Please visit our Medical Necessity Criteria webpage for more information.

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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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