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

region/plan-specific news : Commercial Health Plans in DC, DE, FL, IL, MD, NJ, OK, PA, TX, VA

Providers participate in treatment record and appointment access requests

Magellan compiles annual results of its provider treatment record review (TRR) process applicable to the Magellan center serving commercial health plans in the states listed above. As demonstrated in the full-year 2019 review, providers complied well with most TRR requirements.

Treatment record review results

Contracted Magellan providers respond to us with the requested treatment records, which consist of the entire medical record, including intake forms and disclosures. The following summary compares FY 2018 and 2019 results by treatment record section. 

Treatment record section

2018

2019

1. General

89%

92.5%

2. Client Rights and Confidentiality

50.5%

65.2%

3. Initial Evaluation

86.4%

89.2%

4. Coordination of Care (PCP Communication)

60%

44.5%*

5. Individualized Treatment Plan

85%

89.6%

6. Ongoing Treatment

90.5%

98.4%

7. Medication Management

90%

99.7%

*The member’s mental health therapy can positively impact their medical treatments; the behavioral health provider should share information with the member’s PCP.

 

Treatment record review results for coordination of care

Goal

2018

2019

Coordination of care between the treating clinician and other behavioral health providers

≥ 80%

64.3%

42%**

Evidence of provider request of member for authorization for PCP communication

≥ 50%

59.9%

57%

Evidence of communication with PCP after initial evaluation

≥ 55%

34.2%

50.8%

Evidence of at least one PCP communication at other significant points in treatment

≥ 85%

69.6%

41%***


**Once the behavioral health provider receives member authorization, it’s vital to document—in the record—evidence of coordinating care with other providers, including medical providers, after the member's initial evaluation and on an ongoing basis.

***Providers should communicate with PCPs at significant points in treatment, including when there are safety issues; at the time of significant changes in clinical status such as hospitalization; after medications are initiated or significantly altered; after significant changes in diagnosis or treatment plan; and at treatment termination.

 

Member access to provider appointments

Provider accessibility surveys enable Magellan to determine if providers and facilities are meeting our timeliness standards for access to care—which are crucial elements of quality member service. For individual practitioners, the standards are:

  • Urgent appointments – The member is seen within 48 hours of request.
  • Routine appointments – The member is seen within 14 days of request.

As shown in the following results, and given the significance of urgent member appointment access, Magellan providers should strive to ensure prompt access to care for members in crisis.

 

 

Prescribing provider rate

Non-prescribing provider rate

Level of Urgency

Goal

2018

2019

2018

2019

Urgent ≤ 48 hours

98%

32%

24%

36%

38%**

Routine ≤ 14 days

80%

71%

61%

96%

89%

 

Note: Prescribers are psychiatrists and non-psychiatrist physicians.

2019 MarCom Gold Award Winner 2018 MarCom Gold Award Winner
2017 MarCom Gold Award Winner 2016 MarCom Gold Award Winner

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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