Southwest
After-Hours Audit Performed
Magellan’s Southwest Care Management Center and Michigan Care Management Center recently performed a random audit of provider phone answering systems after normal business hours in Illinois, Michigan and Texas. Of the 462 offices called, 81 percent appropriately directed members to emergent or urgent care.
While Magellan operates on a 24-hour-a-day, seven day-a-week basis, we know that this is not always true for you – particularly if you are in private practice. Because members typically call their providers during a crisis rather than Magellan, it is essential that your telephone instructions are clear on how to obtain emergency services outside of normal business hours.
Please be sure that your answering machine or answering service provides instructions on how to immediately contact emergency services, such as paging you, contacting the on-call provider, going to the nearest emergency room or calling 911.
“The caller in crisis must know when to expect a call back, or what steps to take to be evaluated in person, regardless of the time or day,” says Jane McDonald, senior quality improvement specialist at Magellan’s Southwest Care Management Center.
We urge you to consider the following options in developing an after-hours response procedure:
- Have a professional staff member available to answer calls 24 hours a day; or
- Utilize an after-hours answering service that can direct members to the nearest emergency room or connect them with an on-call provider; or
- Provide a recorded message directing members in an emergency situation to call 911, go to the nearest emergency room, or call a number provided that is staffed by an on-call provider.
If you have any questions regarding this quality initiative in Texas or Illinois, please call the Magellan Southwest Care Management Center at (214) 692-3896 or 1-800-430-0535, ext. 23896. or, in Michigan, call (248) 489-2876 or 1-866-503-3159, ext. 62876.