Frequently Asked Questions
Ambulatory Follow-Up
What is "Ambulatory Follow-Up"?
Ambulatory follow-up is the activity performed by a Magellan care
manager to verify that members keep their outpatient after-care appointments
following discharge from an inpatient facility. This process
is designed to facilitate better coordination of care for
our members.
What is Magellan's role in Ambulatory Follow-Up?
While a member is in an inpatient facility receiving acute care services,
Magellan care managers work with the facility's treatment team
to make arrangements for continued care with outpatient care providers.
It is standard practice for Magellan care managers to contact
the outpatient behavioral healthcare provider within one (1) business
day of the scheduled appointment to verify that the member has
kept the appointment.
What if a member does not keep their outpatient appointment after
discharge?
Informing Magellan as soon as possible enables the care manager to
remove any barriers preventing the member from accessing care. When
a member does not show up for their appointment a care manager or ambulatory
follow-up specialist will begin outreach services to the member.
How does Magellan verify that a member kept their appointment?
A completed claim or encounter form for services rendered is confirmation
that a member kept their aftercare appointment. However, in many
cases we will contact the provider's office within seven (7) days
of the scheduled appointment following discharge from inpatient
care to verify that the member kept the appointment. If the member
is designated as an intensive care management patient according
to risk criteria such as significant diagnosis or readmission
history, the follow-up specialist will also call periodically
after the ambulatory follow-up treatment link is established to
monitor compliance with continued care.
When a claim or encounter form is not submitted in a timely manner, or is incomplete, you may be requested to submit written confirmation of the kept appointment. One example of written confirmation would be a copy of the member's treatment record indicating outpatient services were rendered, including the name of the practitioner who rendered the after-care service and the date of service.
Why would Magellan request written confirmation that the member
kept their appointment?
Written confirmation helps us to keep more thorough, and accurate records.
Confirmation is also required by many of Magellan's client
companies that provide ambulatory follow-up results to quality or regulatory
bodies/agencies such as NCQA and CMS.
How does Magellan protect member confidentiality in ambulatory
follow-up?
The provider is asked only to confirm that the member received
the service authorized by Magellan. It is similar to information that
a provider would supply on a claim form.