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

Are you accessible within a timeframe that reflects the clinical urgency of the member's situation?

Survey results show that appointments are not consistently available within standards.

Magellan has tabulated its 2020 Provider Accessibility Survey – applicable to the Magellan center managing member care in the states listed above – and results reveal that provider appointments are not consistently available to members within timeliness standards, particularly in the areas of non-life-threatening emergent situations (patients should be seen within six hours) and urgent clinical situations (patients should be seen within 48 hours).

Additionally, appointment availability for psychiatrists was well below standard in every area except for new and existing patients seeking routine care.

Most providers represented in the accessibility results were “non-psychiatrists and non-psychologists”—generally comprising social workers, licensed professional counselors and other master’s level practitioners. On average this large group of providers performed well in ensuring adequate access to routine care, but not for higher (urgent and non-life threatening emergent) levels of care.

2020 Provider Accessibility Survey results

Appointment Urgency and Standard

New or Current Patient

All Providers*

Psychiatrist

Psychologist

Non-Psychiatrist/
Psychologist**

Group/ Facility

Non-life Threatening Emergent 

≥95% within 6 hours

New Patient

7.6%

0.0%

13.2%

9.0%

4.7%

Current Patient

9.0%

5.7%

12.0%

10.6%

4.6%

Urgent 

≥98% within 48 hours

New Patient

43.9%

29.6%

30.8%

40.5%

53.5%

Current Patient

45.6%

40.6%

37.2%

42.7%

59.4%

Initial Routine

≥80% within 10 business days

New Patient

83.1%

64.5%

79.1%

81.7%

87.7%

Follow-up Routine

≥70% within 90 days (Prescribers)

OR within 30 days
(Non-Prescribers) 

Current Patient

88.1%

81.9%

86.1%

87.1%

92.3%

Providers reporting appointment access within standards on the 2020 Provider Accessibility Survey


As a Magellan provider, are you accessible within a timeframe that reflects the clinical urgency of the member's situation?


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We ask that you make every effort to be flexible to accommodate member schedules based on their needs.
Not only is this good practice, it’s part of your contractual relationship with us. 

As a Magellan provider, your responsibility for member access to care includes: 

  • Provide immediate emergency services when necessary to evaluate or stabilize a potentially life-threatening situation.
  • Provide services within six hours of referral from Magellan in an emergent situation that is not life-threatening.
  • Provide services within 48 hours of referral from Magellan in an urgent clinical situation or within 24 hours if required by a specific customer benefit plan.
  • Provide services within 10 business days of initial referral for routine clinical situations.  Note: this is the standard for new referrals for routine clinical situations.
  • Provide follow-up services to routine care within the following timeframes:
    • Non-prescribers within 30 days after an initial behavioral health visit.
    • Prescribers within 90 days after an initial behavioral health visit.
  • Provide services within seven days of a member’s discharge after an inpatient stay.

Please review your member access procedures, technologies and overall capacity to ensure that your practice meets the timeliness standards outlined above, as required by your Magellan provider agreement. Particularly with respect to those patients with urgent or higher-level condition severity, prompt access to care is of the utmost importance. 

And be sure to participate in our 2021 survey (the response rate was 30.4% in 2020; we’d love to see more providers weigh in this year).

Finally, always keep your availability up to date by signing in to MagellanProvider.com (select Display/Edit Practice Information).

Thank you for your continuing commitment to meeting the behavioral healthcare needs of Magellan members.



*Includes responses with no recorded practitioner/provider type.

**Includes all non‐psychiatrist, non‐psychologist practitioner responses. Does not include group or facility responses.

2020 MarCom Gold Award Winner 2019 MarCom Gold Award Winner
2018 MarCom Gold Award Winner 2017 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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