Authorization Process
Our philosophy is to authorize care based on a thorough assessment of the member's unique needs to be delivered at the lease intrusive appropriate level and to do so in a timely and efficient manner.
Clinical decisions are based on appropriateness of care and services. We do not pay incentives to employees, physician advisors, or providers to reduce or forego the provision of medically necessary care. We do not reward or offer incentives to encourage non-authorizations or under utilization of behavioral health services. Our employees are required to attend company compliance training that addresses this policy.
To comply with this policy, your responsibility is to:
- Contact Magellan online at MagellanHealth.com or by phone for an initial authorization of care as required by the member’s benefit plan
- Provide Magellan with a thorough assessment of the member so that an appropriate authorization determination can be made
- Call the Care Management Center that authorized care for a treatment review if during the course of treatment you determine that services other than those authorized are required
Magellan's responsibility is to:
- Make an authorization decision based upon the initial assessment with you
- Include the type of service(s), number of sessions or days authorized, and a start- and end-date for authorized services in the authorization decision
- Communicate authorization decisions by telephone, online and/or in writing to you and the member
- Offer you the opportunity to discuss the determination with a Magellan peer reviewer if we are unable to authorize the requested services based on the medical necessity criteria review and you did not speak with a Magellan peer reviewer prior to the decision
- Provide you with contact information for the physician advisor