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

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

Scores increase in multiple areas of providers' treatment records

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. In 2021, providers complied well with most TRR requirements.

Treatment record review results

Contracted Magellan providers provide us with the requested treatment records, which consist of the entire medical record, including intake forms and disclosures. The following summary compares FY 2020 and 2021 quality results by treatment record section. 

Treatment record section

2020

2021

1. General

93.7%

92.8%

2. Client Rights and Confidentiality

55.7%

62.68%

3. Initial Evaluation

92.7%

92.9%

4. Coordination of Care (PCP Communication)

35.8%

50.3%

5. Individualized Treatment Plan

89.4%

91.94%

6. Ongoing Treatment

99.1%

99.44%

7. Medication Management

99.2%

98.21%

Results indicate improvement in five of the seven measures, most notably Coordination of Care (PCP Communication). As you know, a member’s mental health can impact their medical treatments (and vice versa), so it’s important to share information with the member’s PCP. Thank you for your commitment and attention to this area!

Coordination of care measures

In the table below, coordination of care is further broken down. Results show an increase in all measures.

 Treatment record review results for coordination of care

Goal

2020

2021

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

≥ 80%

34.0%

97.06%

Evidence of provider request of member for authorization for PCP communication

≥ 50%

45.2%

50.89%

Evidence of communication with PCP after initial evaluation

≥ 55%

32.8%

64.08%

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

≥ 85%

27.3%

100%

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.

2021 MarCom Gold Award Winner 2020 MarCom Gold Award Winner
2019 MarCom Gold Award Winner 2018 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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