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Magellan Healthcare, Inc.* 2021 2022 Magellan Care Guidelines

Details: 2021 – 2022 Magellan Care Guidelines 5 Medical Necessity Definition Magellan reviews mental health and substance abuse treatment for medical necessity. Magellan defines medical necessity as: “Services by a provider to identify or treat an illness that has been diagnosed or suspected.

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Magellan Healthcare, Inc.* 2021 Handbook for the National

Details: The Magellan Health affiliate, Magellan Health care, offers customers a broad array of mental health and substance abuse clinical management services that combines the best of traditional approaches to healthcare delivery with innovative, emerging solutions. Depending on your credentials, skills and

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Magellan Care Guidelines 2021-2022 summary of revisions

Details: and health outcomes, and results from this social determinants of health assessment should inform individual treatment plans and identify potential interventions to facilitate discharge planning and transitions of care. The assessment is available in the Behavioral Health Level of

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Senior Whole Health

Details: Senior Whole Health. Handbook Supplement (PDF) Provider Orientation. Massachusetts Training Deck (PDF) New York Training Deck (PDF) Authorization Quick Guide by Level of Care (PDF) Retrospective Review Form (PDF) Appointment of Representation Form (PDF) Other Resources. COVID-19 vaccine FAQs; New York provider materials

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Telehealth Provider Frequently Asked Questions

Details: Convenient – deliver behavioral health services from your home, office or when traveling Simple – connect with patients using your private computer with a camera and high-speed internet Secure and private – HIPAA-compliant platform Opportunity for extra income – offer additional and/or non-standard appointment hours

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Virginia BHSA Handbook Supplement

Details: Virginia BHSA Provider Handbook Supplement 6—© 2013-2021 Magellan Health, Inc. 06/21 SECTION 2: MAGELLAN’S BEHAVIORAL HEALTH NETWORK Network Provider Participation Our Philosophy Magellan is dedicated to selecting behavioral healthcare professionals, groups, agencies and facilities to provide member care and treatment

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New York Inpatient Substance Use Disorder and Mental

Details: inpatient mental health treatment for members of all ages. All inpatient mental health services provided by such facilities are subject to concurrent review throughout the admission. Providers with questions regarding these changes are encouraged to call Magellan during regular business hours, at 1-800-778-2119 for behavioral health. Resources:

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Quick Reference Guide for Serving Blue Shield of

Details: Blue Shield of California Mental Health Service Administrator (MHSA) P.O. Box 710400 . San Diego, CA 92171-0400 . Appeals. Magellan supports the rights of members and their providers acting on the member’s behalf to appeal adverse determinations. The procedure for appealing a clinical determination is outlined fully in the

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7TH ANNUAL Oncology Summit

Details: 8:15 a.m. Health plan benefits- objectives and products under the health care umbrella Renee Rizzo Fleming, RPh, MBA—PRN Managed Care Consulting Services, LLC 9:00 a.m. The role of today’s pharmacy director George S. Hiller, III, RPh—The Hiller Pharmacy Management Group 9:45 a.m. Break 10:00 a.m. The role of today’s medical director

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IH MRxM Vizimpro 07 19

Details: discretion of the health plan. Medicare Part B Covered Diagnosis Codes (applicable to existing NCD/LCD): N/A Medicare Part B Administrative Contractor (MAC) Jurisdictions Jurisdiction Applicable State/US Territory Contractor E (1) CA, HI, NV, AS, GU, CNMI Noridian Healthcare Solutions, LLC

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What You Need to Know About Credentialing and Contracting

Details: *In California, Magellan does business as Human Affairs International of California, Inc. and/or Magellan Health Services of California, Inc. – Employer Services. Other Magellan entities include Magellan Healthcare, Inc. f/k/a Magellan Behavioral Health,

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Criteria Pertaining to All Professionals

Details: National Provider ©2009-2020 Magellan Health, Inc. Page 1 Handbook Rev.08 /19 Criteria Pertaining to All Professionals 1. All professionals must hold a current license in their specialty at the highest level in the state in which they practice. Licensure must be for independent practice.

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Request for Psychological Testing Preauthorization

Details: Request for Psychological Testing Preauthorization Instructions Rev 09/2020 v. 11 ©2004-2020 Magellan Health, Inc. Page 1 The Request for Psychological Testing Preauthorization form is necessary to authorize psychological testing. • In-network provider: Complete the authorization request online at www.MagellanProvider.com via the Request Member Care application, or upload the

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Quick Reference Guide for Magellan Healthcare

Details: Health Plans Authorizations and Eligibility Claims Submission Kaiser Permanente: Commercial, Medicare, and Medicaid (MediCal) To verify eligibility and for authorization questions, contact Magellan at: 1-800-327-5479 Paper Claims Address Magellan Healthcare P.O. Box 1116

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Client Information Form

Details: Client Information Form Client Signature _____ ©2004-2019 Magellan Health, Inc. This document is the proprietary information of Magellan.

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National Telehealth Billing Instructions

Details: 2) Telehealth is defined by Magellan as a method of delivering behavioral health services using interactive telecommunications when the member and the behavioral health provider are not in the same physical location. Telecommunications MUST be the combination of audio and live, interactive video.

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Medical Necessity Criteria Guidelines

Details: with mental health problems that require an inpatient setting due to potential for harm to self or to others or potential for harm to self due to an inability to adequately care for his/her personal needs without presenting an

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Provider Handbook Supplement for US Family Health Plan

Details: making health care decisions. Our Policy As appropriate, Magellan will inform adult members 18 years of age or older about their rights to refuse, withhold, or withdraw medical and/or mental health treatment through advance directives. Magellan supports state and federal regulations, which provide for

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AmeriHealth* Quick Reference Guide for participating providers

Details: Health plans Prefix Emdeon payer Paper claim Authorizations and eligibility 1 information ISA-08 GS-03 mailing address Authorizations 1-800-809-9954 Verify eligibility and benefits at www.pearprovider.com AmeriHealth non-HMO (NJ) Authorizations 1 -800-634-5334 To contact AmeriHealth Administrators 1-800-492-2385

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CarePlus Quick Reference Guide

Details: ©2017-2020 Magellan Health, Inc. rev. 06/2020 CarePlus Quick Reference Guide *Clay and Volusia counties added effective Jan. 1, 2020. Authorizations Magellan uses our streamlined clinical management model for outpatient treatment for CarePlus members.

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Louisiana CSoC Handbook Supplement

Details: specialized behavioral health services for Medicaid-eligible children and youth potentially eligible for or enrolled in the Coordinated System of Care (CSoC) waiver, and the services are facilitated by the Wraparound agencies. The four specialized CSoC services are provided by community-based providers,

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Temporary Disability Retired List (TDRL) Examinations

Details: Health Administration (OSHA) guidelines and wheelchair accessible. And, if free parking is not available for the veteran or service member, you must be willing to validate for parking as the veteran or service member is not expected to pay for parking. What is the process for claims

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What You Need to Know About Group Contracting and Group

Details: affiliates of Magellan Health, Inc. (collectively “Magellan”). To clarify the process of becoming a Magellan* network group provider, we’ve compiled a list of frequently asked questions we receive about credentialing and group contracting.

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Instructions: Complete the form in its entirety, as

Details: For behavioral health providers serving Senior Whole Health members only ©2004-2021 Magellan Health, Inc. This document is the proprietary information of Magellan. Rev: 04/01/2021 A retrospective review is an evaluation for the medical necessity of treatment services after the treatment has been rendered without preauthorization.

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Magellan Complete Care Providers User Sign In

Details: ©2013-2021 Florida MHS, Inc. d/b/a Magellan Complete Care a subsidiary of Magellan Health, Inc. All Rights Reserved. Terms and Conditions of Use

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National Provider Identifier (NPI)

Details: For claims submitted via the ASC X12N 837 professional health care claim transaction, place the Type 2 NPI in the provider billing segment, loop 2010AA; place the Type 1 NPI in loop 2310B. On the CMS-1500 form, insert billing Type 2 NPI in Box 33a; insert service facility Type 2 NPI (if different from billing NPI) in Box 32a; insert Type 1 NPIs

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State-, Plan- & EAP-Specific Information

Details: State-, Plan- and EAP-Specific Information. Click below to view handbook supplements, forms, and additional tools and information available for your use in serving members of specific health plans or in certain states. Providers must be familiar with and follow the policies and procedures contained within all applicable supplements to Magellan

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1. HOSPITALIZATION

Details: H0035 Mental health partial hospital, treatment, less than 24 hours 3.2 Partial Hospitalization, Substance Use Disorders, Rehabilitation Treatment. Assists individuals who require structure for a portion of the day. These programs are designed to restore or maintain the functioning of individuals with serious mental and/or substance abuse

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Using Correct License-level Modifiers on Your Claims

Details: ©2005-2021 Magellan Health, Inc. Last reviewed 02/2021 Using Correct License-level Modifiers on Your Claims Magellan organizational providers and individual providers submitting professional claims as part of an organization (using the organization’s Taxpayer Identification Number) must submit claims with the license-level modifier that represents the treating provider’s license level.

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Magellan Behavioral Health of Pennsylvania, Inc.* Provider

Details: Pennsylvania Health hoices’ Program Provider Handbook Supplement 6—©2004-2020 Magellan Health, Inc. rev. 11/20 SECTION 1: INTRODUCTION Welcome Welcome to Magellan Behavioral Health of Pennsylvania, Inc. (Magellan). This Provider Handbook Supplement is designed to give Magellan network providers specific information on

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2018-2019 Magellan Care Guidelines

Details: mental health problems that require an inpatient setting due to potential for harm to self or to others or potential for harm to self due to an inability to adequately care for his/her personal needs without presenting an imminent threat to himself/herself or to others. b. The purpose of subacute care programs is to provide rehabilitation and

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Active Network Providers

Details: Active Network Providers. Magellan providers are licensed and credentialed to high industry standards and have documented experience in the treatment of mental illness and/or substance abuse. Network providers must: Be both credentialed and contracted with Magellan. Become recredentialed every three years, unless otherwise required by a

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Veterans Affairs (VA) Compensation and Pension Examinations

Details: ©2016-2019 Magellan Health, Inc. Rev. 01/19 the veteran calls your office to reschedule an appointment, please refer to them to QTC. What is the process for claims submission? Once the disability examination is completed and the DBQs and required forms have been

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Magellan Rx Specialty Client Providers User Sign In

Details: © 2005-2021 Magellan Health, Inc. All Rights Reserved. Terms of Use; Disclaimer; Privacy Policy

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California Telehealth Billing Instructions

Details: 2) Telehealth is defined by Plans as a method of delivering behavioral health services using interactive telecommunications when the member and the behavioral health provider are not in the same physical location. Telecommunications MUST be the combination of audio and live, interactive video.

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Obesity Clinical Practice Guideline

Details: Obesity is a public health issue associated with multiple comorbidities, e.g., cardiovascular disease and cancer, and with a higher risk of all-cause mortality (Ladabaum et al., 2014). Authors noted that more than two-thirds of adults in the United States are obese or overweight

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Mental Health Rehabilitative and Mental Health Targeted

Details: Mental Health Rehabilitative services and Mental Health Targeted Case Management (TCM) services are available to Texas STAR Kids recipients who are assessed and determined to have: •A severe and persistent mental illness such as schizophrenia, major depression, bipolar disorder or other severely disabling mental disorder.

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Transcranial Magnetic Stimulation (TMS) Fax Cover Sheet

Details: Western Health Advantage member fax: 1-888-656-4789 . Blue Shield of California member fax: 1-888-656-3510. Or complete and submit online: www.MagellanProvider.com (sign in and select . Request Member Care) For initial requests, complete this fax cover sheet and the TMS checklist, sections I-VI.

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Magellan Behavioral Health of Pennsylvania, Inc. Incident

Details: ©2006-2014 Magellan Health, Inc. This document is the proprietary information of Magellan. Definitions Sentinel Event Consistent with The Joint Commission’s 2015 Sentinel Event Policy and Procedures for Behavioral Health Care accredited facilities 1, Magellan Behavioral Health of Pennsylvania, Inc. has defined a Sentinel Event as an Incident

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2017-2018 Magellan Care Guidelines

Details: mental health problems that require an inpatient setting due to potential for harm to self or to others or potential for harm to self due to an inability to adequately care for his/her personal needs without presenting an imminent threat to himself/herself or to others. b. The purpose of subacute care programs is to provide rehabilitation and

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Magellan Institute of Diversity and Cultural Excellence

Details: Behavioral health service systems and local provider organizations should offer culturally specific community education programs about the behavioral health system and the risk factors associated with specific disorders. The goal is to increase the capacity of families from all

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Initial Evaluation Template

Details: Initial Evaluation Template ©2017 Magellan Health, Inc. rev. 11/17 Page 3 Family Medical History: _____ Current Medications (Include prescribed dosages, dates of initial prescription and refills, and

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California Quick Reference Guide

Details: Western Health Advantage (WHA) PO Box 710430 San Diego, CA 92171 Kaiser Permanente 1-800-327-5479 Claims Mailing Address PO Box 1116 Maryland Heights, MO, 63043 Appeals Magellan ATTN: Kaiser Appeals PO Box 710430 San Diego, CA 92171 State of CA (SOC) 1-866-327-4762 Claims Mailing Address PO Box 710430 San Diego, CA 92171 Health Plan of

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Fraud, Waste and Abuse Training for Medicare and Medicaid

Details: Being excluded means no payment will be made by any federal health care program for any items or services furnished, ordered or prescribed by an excluded individual or entity. à. No excluded individual or entity may provide goods or services reimbursed by a federal health care …

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Screening, Brief Intervention, and Referral to Treatment

Details: Magellan offers support to health plans in collaborating with primary care physicians to implement Screening, Brief Intervention, and Referral to Treatment (SBIRT). SBIRT is a comprehensive, integrated approach to early intervention and treatment services for people with substance use disorders, as well as those at risk of developing these

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Magellan Treatment Request Form (TRF) Instructions

Details: Magellan Treatment Request Form (TRF) Instructions ©2013-2014 Magellan Health, Inc. rev 8/14 What is a TRF and How is it Used?

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Improving care after hospitalization for mental illness

Details: health provider to occur within seven days of discharge from an acute inpatient setting, even when discharging on a weekend. • The seven-day appointment can be with a behavioral health therapist and does not need to be with a psychiatrist. • Ensure members have an actual verified appointment, not a walk-in appointment.

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