Provider Handbook Updated for 2010
Your Magellan National Provider Handbook has been updated for 2010 and is available on this website.
Please note a number of important updates to the handbook for 2010:
- Clarification about how providers can appeal decisions that affect network participation status (p. 2-6)
- New information about our providers’ role in Magellan’s outcomes measurement system, Outcomes360 (p. 3-3, 3-5, 4-1 and 4-7)
- An updated list of the “new technologies” Magellan considers investigational (p. 3-15)
- New information about how providers can effectively use Magellan’s website to reduce administrative time (p. 3-18)
- A detailed explanation of providers’ fraud and abuse prevention obligations to Centers for Medicare and Medicaid Services (CMS) and to Magellan (p. 4-18).
Our updated provider handbook appendices include:
- Our three Clinical Practice Guideline Audit Checklists in Appendix A
- Updated professional provider selection criteria for nurses with prescriptive authority in Appendix B
- The new 2010 Medical Necessity Criteria and provider comment form in Appendix C
- An updated list of Magellan-approved claims clearinghouses for provider electronic claims submission in Appendix F
- Updates to the medical detoxification Clinical Practice Monograph in Appendix H
- An updated false claims law and whistle-blower protections policy, and the Medicare and Medicaid fraud and abuse compliance programs in Appendix J.
In addition to the National Provider Handbook, the following Magellan handbook supplements recently have been updated and are available online:
- Magellan Organizational (i.e., facility) Supplement
- EAP Supplement
- Florida Medicaid (for Molina Healthcare and for Prepaid Mental Health Plan [PMHP] areas 2, 4, 9, 11 and Child Welfare)
- Georgia Medicaid
- Nebraska Medicaid
- Pennsylvania HealthChoices
- Texas Medicaid
- Kentucky, Indiana and Ohio Facility
- New York - Group Health Insurance (GHI)
- Vermont.
You can find state-, plan- and EAP-specific information under the “News & Publications” top-menu item on this website.
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 lines of business for which you are eligible to see members.