region/plan-specific news
: Commercial Health Plans - excluding California
Providers' treatment records highlight strong performance and targeted opportunities
Records Magellan reviewed from 2025 show consistent quality across most measures, with continued focus needed on care coordination and client rights
Magellan compiles annual results of its provider treatment record review process applicable to the Magellan center serving commercial health plans in the states other than California. As reflected in 2025 results, providers complied well with most requirements.
Where providers performed well
Contracted Magellan practitioners provide us with the requested treatment records consisting of the entire medical record including intake forms and disclosures. The following summary compares CY 2024 through CY 2025 quality results by treatment record section.
|
Treatment record section |
2024 |
2025 |
|
1. General |
95% |
92% |
|
2. Client Rights and Confidentiality |
59% |
57% |
|
3. Initial Evaluation |
94% |
98% |
|
4. Coordination of Care (PCP Communication) |
56% |
45% |
|
5. Individualized Treatment Plan |
96% |
96% |
|
6. Ongoing Treatment |
99% |
99% |
|
7. Medication Management |
100% |
89% |
Results indicate steady performance in five of the seven measures over the past two years,
while highlighting opportunities for improvement in the Coordination of Care (PCP Communication)
and Client Rights and Confidentiality measures which continue to fall well below the ≥80% target.
As you know, a member’s mental health can impact their medical treatments (and vice versa), so it is important to share information with the member’s PCP.
Opportunities for improvement
The table below further breaks down results for coordination of care. Results show that there are opportunities for improvement in 1) communication between behavioral health and PCPs, as well as 2) provider requests for member authorization of communication with PCPs.
|
Treatment record review results for coordination of care |
Goal |
2024 |
2025 |
|
Coordination of care between the treating clinician and other behavioral health providers |
≥ 80% |
96% |
42% |
|
Evidence of provider request of member for authorization to communicate with the PCP |
≥ 80% |
52% |
52% |
|
Evidence of communication with PCP after initial evaluation |
≥ 80% |
59% |
14% |
|
Evidence of at least one PCP communication at other significant points in treatment |
≥ 85% |
92% |
75% |
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.
Coordinating care with other providers
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
- At treatment termination
Resources to support quality documentation
- National Provider Handbook — Section 4: The Quality Partnership
www.MagellanProvider.com/handbook - Treatment Record Forms — See informed consent for treatment, clinician communication form, and member rights and responsibilities statements
www.MagellanProvider.com/clinicalforms
We appreciate your efforts to increase the provision of well-integrated, whole-health member care.