Magellan believes it is important to monitor organizational data, follow industry best practices and changing government regulations, regularly assess innovations in the treatment of behavioral health disorders, and encourage open feedback from our providers and other stakeholders. We use the knowledge gathered from these channels to review and revise our policies, procedures and practices as appropriate.
As part of the annual review of the Magellan National Provider Handbook, Magellan just released our 2011 Medical Necessity Criteria (MNC), which becomes effective Jan. 1, 2011 (found in Appendix C). To ensure the relevancy and timeliness of our MNC, we sought suggestions from stakeholders throughout the year.
In line with industry standards and the U.S. Department of Health’s Centers for Medicare and Medicaid Services (CMS) National Correct Coding Initiative (NCCI), Magellan is vehemently monitoring claims for outpatient services and strictly enforcing established criteria.