• State False Claims Laws (PDF 452K)

• Maricopa County providers should visit www.MagellanofAZ.com.
• Requesting Claim Information the Provider Already Has Submitted (PDF 79K)

Handbook

Handbook Supplement (PDF 41K)

• Appendix A: Audit Tools
• Appendix B: Professional Provider Selection Criteria
• Appendix C: California Medical Necessity Criteria
• Appendix D: Member and Provider Rights, Responsibilities
• Appendix E: Clinical Practice Guidelines
• Appendix F: California Member Grievance Form -- English (PDF 19K)
• Appendix F: California Member Grievance Form -- Spanish (PDF 19K)
• Appendix G: Independent Medical Review Policy (PDF 28K)
• Appendix H: Claims Settlement Practices and Dispute Resolution (PDF 47K)
• Appendix I: Language Assistance Services (PDF 62K)

Language Capability Verification Form (PDF 40K)

California Provider Quick Reference Guide (PDF 23K)

• Maryland Medical Necessity Criteria for Residential Crisis Services (PDF 29K)

• NJ provider appeal form

• Handbook Supplement (PDF 137K)

• North Carolina Definition of Medically Necessary Services or Supplies (PDF 29K)

• PA Act 68 Communication of UR Decisions - Quick Reference Guide (PDF 20K)
• Criteria for Behavior Analysts (PDF 40K)

• Handbook Supplement (PDF 181K)
• Quick Reference Guide (PDF 34K)

One significant component of this provider handbook supplement has been updated. While the policies comprising the Handbook Supplement document below remain in force, providers should utilize the Medical Necessity Criteria -- Revised document in place of the criteria that are housed in the original 2004 Handbook Supplement version, pages 46 through 86.

• Handbook Supplement (PDF 956K, 2-3 minutes)
• Medical Necessity Criteria -- Revised (PDF 182K)
• Handbook Appendices (PDF 604K, 1-2 minutes)
• Non-Discrimination Training
• PINS Training
• Provider Notice -- Employee and Contractor Screening (PDF 150K)

• AmeriHealth Quick Reference Guide (PDF 150K)
• AmeriHealth provider appeal form
• Claim Requirements – National Provider Identifier (NPI) (PDF 38K)
• Outpatient Mental Health Authorization Removal Information

• BCBS of North Carolina Authorization to Use or Disclose Protected Health Information (PDF 121K)

• Capital BlueCross Quick Reference Guide (PDF 150K)
• Magellan Autism Connections^SM Program Provider Q&A (PDF 30K)

Prepaid Mental Health Plan

Contact Information (PDF 10K)

Molina Healthcare of Florida

Provider Handbook Supplement (PDF 141K)

Area 2

Provider Handbook Supplement (PDF 36K)

Appendices

• Appendix A: Clinical Practice Guidelines
• Appendix B: Medical Necessity Criteria Area 2 (PDF 458K)
• Appendix C: Enrollee Rights and Responsibilities – English (PDF 36K)
• Enrollee Rights and Responsibilities – Spanish (PDF 36K)
• Enrollee Rights and Responsibilities – Creole (PDF 36K)

Area 4

Provider Handbook Supplement (PDF 33K)

Appendices

• Appendix A: Clinical Practice Guidelines
• Appendix B: Medical Necessity Criteria Area 4 (PDF 458K)
• Appendix C: Enrollee Rights and Responsibilities – English (PDF 36K)
• Enrollee Rights and Responsibilities – Spanish (PDF 36K)
• Enrollee Rights and Responsibilities – Creole (PDF 36K)

Area 9

Provider Handbook Supplement (PDF 366 K)

Appendices

• Appendix A: Clinical Practice Guidelines
• Appendix B: Medical Necessity Criteria Area 9 (PDF 400K)
• Appendix C: Enrollee Rights and Responsibilities – English (PDF 36K)
• Enrollee Rights and Responsibilities – Spanish (PDF 36K)
• Enrollee Rights and Responsibilities – Creole (PDF 36K)

Area 11

Provider Handbook Supplement (PDF 501K)

Appendices

• Appendix A: Clinical Practice Guidelines
• Appendix B: Medical Necessity Criteria Area 11 (PDF 442K)
• Appendix C: Enrollee Rights and Responsibilities – English (PDF 36K)
• Enrollee Rights and Responsibilities – Spanish (PDF 36K)
• Enrollee Rights and Responsibilities – Creole (PDF 36K)

Child Welfare

Provider Handbook Supplement (PDF 362K)

Appendices

• Appendix A: Clinical Practice Guidelines
• Appendix B: Medical Necessity Criteria (PDF 340K)
• Appendix C: Enrollee Rights and Responsibilities – English (PDF 36K)
• Enrollee Rights and Responsibilities – Spanish (PDF 36K)
• Enrollee Rights and Responsibilities – Creole (PDF 36K)

Treatment Record Review

Treatment Record Review Tool (PDF 10K)

• Handbook Supplement (PDF 212K)
• Medical Necessity Criteria (PDF 449K)
• Quick Reference Guide -- WellCare HMO (PDF 92K)

Guardian Quick Reference Guide (PDF 23K)

• Horizon BCBS of NJ Quick Reference Guide (PDF 58K)
• Horizon BCBS of NJ provider appeal form

• Independence Blue Cross Health Plan Quick Reference Guide (PDF 147K)
• Claim Requirements – National Provider Identifier (NPI) (PDF 38K)
• Outpatient Mental Health Authorization Removal Information
• Magellan Autism Connections^SM Program Provider Q&A (PDF 30K)
• Outcomes 360 Member Self-Administration Tips (PDF 66K)
• SF-BH Member Flyer Handout (PDF 100K)
• SF-BH Member Summary Handout (PDF 96K)

• Indiana Medicaid Supplement (PDF 225K)

Appendices

• Appendix A: Treatment Request Form (PDF 41K)
• Appendix B: Data Sharing Tool (PDF 82K)

• Provider Handbook (PDF 251K) (Effective until 12/31/2009)
• Provider Handbook (PDF 258K) (Effective 1/1/2010)
  • Appendix A: Definition of Psychosocial Necessity Medicaid Mental Health (PDF 220K)
  • Appendix B: Services that Do Not Require Authorization (PDF 45K)
  • Appendix C: Intensive Care Management (PDF 25K)
  • Appendix D: Clinical Reconsideration (PDF 30K)
  • Appendix E: Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals (PDF 113K)
  • Appendix F: Medicaid - LPHA/Remedial Process (PDF 140K)
• Treatment Record Review Tool (PDF 121K)
• Retrospective Review for Substance Abuse Form (PDF 109K)
• Treatment Planning Presentation (PDF 370K)
• Electronic Claim Submission Presentation (PDF 72K)

• Handbook Supplement

The MagellanofAZ.com Web site offers a full range of tools and information that providers can use in delivering quality behavioral health care to Maricopa County recipients. All policies and procedures applicable to Magellan providers under the Maricopa County Regional Behavioral Health Authority (RBHA) program can be found on MagellanofAZ.com.

In addition, tools are available on the MagellanProvider.com Web site to help you provide care, including:

• Submit Intake, Check Eligibility & Authorizations
• View Crisis Plans/Advance Directives
• Request Member Services/Unmet Needs
• Check Appointment/Bed Availability

Sign-in to access the above tools.

• Handbook Supplement & Appendices
• Nebraska Medicaid Managed Care Plan Outpatient Reimbursement Schedule (PDF 74K)
• Interpretive Guidelines and Standards
• Notifications
• Clinical Workflows (PDF 1.26M)
• CFS Registration User Guide (PDF 200K)
• Perspectives on Residential and Community-Based Treatment for Youth and Families (PDF 118K)
• Nebraska provider directory Web instructions (PDF 20K)

• Handbook Supplement (PDF 209K)

• Handbook Supplement and Appendices
• Provider Orientation (PDF 210K)
• Montgomery County Provider Profiling
• Recovery Assessment Scale
• Instructions -- Recovery Assessment Scale (PDF 913K)
• HealthChoices HealthConnections Member Survey
  • Instructions -- Member Survey (PDF 523K)

• Handbook Supplement (PDF 301K)