This is the Magellan website for behavioral health providers
Magellan Health

Pennsylvania HealthChoices

Handbook Supplement (PDF)

 

APPENDIX A – Forms and Processes 

Adverse Incident Reporting Packet (Update notice - rev. 2/4/16)

Alternatives to Residential Mental Health Form, Attachment 8

Children in Substitute Care (CISC) Referral Form

Consent to Release Protected Health Information (PHI)

Discharge Summary

Initial Referral for Family Based Services

ISPT Sign-In/Concurrence Form

Life Domain Format Guidelines

Medication Problem Report

Mental Health Services in School Coordination Form

PCP Communication Form

Pennsylvania Client Placement Criteria III (PCPC-III) Summary Form

Plan of Care Summary

Provider Access Form

Request for Psychological Testing Preauthorization Form

Treatment Authorization Request Cover Sheet

Treatment Authorization Request Form

 

APPENDIX B – County-Specific Forms

Bucks County CQC Treatment Authorization Request Cover Sheet

Bucks, Delaware and Montgomery County Referral for BHRS Services

Delaware County CQC Treatment Authorization Request Cover Sheet

Delaware County EAS CQC Treatment Authorization Request Cover Sheet

Lehigh, Northampton County Cultural Competence Implementation Audit Tool

Lehigh, Northampton County LGBTQI Audit Tool

Lehigh, Northampton, Cambria County Request for Reauthorization – Family-Based Services

Lehigh, Northampton County EI BHRS Treatment Authorization Request Cover Sheet

Montgomery County CQC Treatment Authorization Request Cover Sheet

Montgomery County EAS CQC Treatment Authorization Request Cover Sheet