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

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

Treatment record reviews show need to document care coordination

Magellan’s quality improvement staff (managing member plans in the states listed above) conducts annual treatment record reviews of a representative sample of network providers’ documentation.

The tabulated reviews result in an aggregated score for the completeness of our network providers’ treatment records, organized in the categories below.

Treatment Record Section

2017

2018

General

95.9%

89.0%

Client Rights and Confidentiality

48.1%

50.5%

Initial Evaluation

96.6%

86.4%

Coordination of Care

29.8%

59.9%

Individualized Treatment Plan

82.4%

85.1%

Ongoing Treatment

91.2%

90.5%

Medication Management

77.8%

90.1%

Addendum for Special Populations

83.6%

84.5%

Once you receive 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.

While many 2018 results improved over those obtained in 2017, several areas of documentation still require providers’ attention and improvement. For example, coordination of care results—segmented and listed with their respective quality goals in the table below—mostly fell short of targets.

Treatment Record Review Results for Coordination of Care

Goal

2018

Evidence of provider request of member for authorization for PCP communication

≥ 50%

59.1%

Evidence of communication with PCP after initial evaluation

≥ 55%

32.4%

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

≥ 80%

64.3%

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

≥ 85%

69.5%

Obtaining the member’s permission to communicate with other providers, including primary care physicians (PCPs), is an integral care coordination step ensuring that the member is treated from a whole health perspective.

It's the provider’s role to educate members on why it is important to authorize communication with the PCP and other providers.

After you receive the member's authorization, it’s imperative to document evidence of coordinating care with other providers, after the initial evaluation and on ongoing.

Thank you for working with Magellan to improve behavioral healthcare and service for members.

2018 MarCom Gold Award Winner 2017 MarCom Gold Award Winner
2016 MarCom Gold Award Winner 2015 MarCom Platinum Award Winner

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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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