Magellan complete care provider manual

We’ve recently updated the Magellan National Provider Handbook and several of the handbook supplements that pertain to EAP providers and to serving specific plans and/or states. These important resources are located on our provider website at www.MagellanProvider.com/handbook.

Note the following revisions to the Magellan National Provider Handbook:

Section 1: Introduction

• Updated About Magellan and Our Products to include our new digital wellbeing tool, eMbrace, used in conjunction with employee assistance programs and Autism Connections, going beyond traditional care.

Section 2: Behavioral Health Network

• Clarified your responsibility to review quarterly and maintain the accuracy of your administrative practice information using Magellan’s provider portal (or contracted vendors as directed) in Network Provider Participation and in Updating Practice Information.
• Explained that we do not cover clinical services provided before your contract and any required addenda or attestations have been processed in Contracting with Magellan.

Section 3: Role of the Provider and Magellan

• Revised Care Management Overview and Care Management to further describe how we facilitate member access to appropriate services and provide outreach to members and providers in acute care situations.
• Added information about online benefit certification in Before Services Begin.
• Clarified our policy regarding your role in Options to Request Reversal of an Adverse Benefit Certification.
• Explained the use of peer support in our clinical model called Recovery Support Navigation services.
• Presented Magellan Care Guidelines.
• Added information about online capabilities and encouraged your frequent use of provider portals as a self-service tool for supporting your practice under Provider Website.

Section 4: Quality Partnership

• Added expectations for all clinical professionals regarding Cultural Sensitivity.
• Updated HEDIS ® and Performance Measurement and the importance of measuring clinical outcomes as an essential component of high-quality care delivery in Outcomes360 SM .
• Explained the value of Provider Input and invite you to join our online provider advisory group.
• Updated the description of “desk audits” conducted by us as a prevention activity in Fraud, Waste, Abuse and Overpayment.

Section 5: Provider Reimbursement

• Updated our information about setting up Electronic Funds Transfer for claims payment.
• Updated the following Appendix documents:
  • What You Need to Know About Credentialing and Contracting for Individuals
  • Professional Provider Selection Criteria
  • Policies: Medicaid Program Integrity and Medicare Advantage Compliance Program Policies, False Claims Laws and Whistleblower Protections Policy

  Changes to the Magellan Handbook Supplement for Organizational and Facility Providers included:

  Section 2: Provider Network

  • Updated Communications describing efficient online methods of interacting with us including the entry of changes in administrative information about your organization.

  Section 3: Role of the Provider

  • Outlined the collaborative relationship between your organization, the member and our care management team in Before Services Begin.
  • Clarified your role in Appealing Care Management Decisions.

  Section 4: Quality Partnership

  • Explained our provider reimbursement arrangements based on quality rather than quantity of care in Value-Based Collaboration and Compensation.

  Section 5: Provider Reimbursement

  • Updated our preferred lists of HIPAA-compliant coding resources in Billing Codes and HIPAA Compliance.

  In accordance with your agreement(s) with Magellan and/or its affiliated companies, you should adhere to the policies and procedures outlined in the national handbook and any supplements that apply to states in which you practice or benefit plans for which you are eligible to see members.

  
  

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  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.