You'll know that a member's service requires authorization when you check the member's eligibility. If you are uncertain, please verify by contacting us via the phone number on the back of the member's benefit card.

Pre-Authorization is typically required for facility and non-routine outpatient services. Examples of these types of services are:

• transcranial magnetic stimulation,

• psychological testing,

• residential treatment,

• partial hospitalization and intensive outpatient

If your authorization is required, then sign in and navigate to Request Member Care.

Most routine, outpatient visits do not require pre-authorization or concurrent review. If authorization is not needed, then you only need to file the claim. Magellan may call or email to followup.

Delivering quality care starts with an accurate and thorough assessment of the member’s needs.

Purpose

The purpose of an assessment or screening is to evaluate a member's individual needs in order to assess if the user should receive an authorization for a requested service.

Providing an Assessment

An assessment may be conducted prior to making the referral by Magellan's Member Care Team or during the member's visit by yourself (the provider's practice team). Whether the assessment occurs before or after will depend on the member's benefits plan.

Provider Assessment

Your member assessment may be submitted verbally over the phone or by fax to the Member Care Team.  The assessment should include, but not be limited to...

• symptoms,

• event(s) precipitating the call,

• potential harm to self or others,

• treatment history,

• any additional information that you deem substantive to the member's care needs.

Our care management team is happy to assist if you have any questions. Contact us at the number on the member’s benefit card.

Psychological testing is the use of one or more standardized measurements, instruments or procedures to observe or record human behavior. Appropriate normative data must be applied to assess. Psychological testing may be used to either assist in differential diagnosis of psychiatric disorders or to assist in the assessment of response of those disorders to treatment.

Pre-authorization is required for psychological testing. Prior to administering the psychological testing, you must complete and submit the Magellan Psychological Testing Preauthorization.

Psychological Testing Authorization

Before administering testing, complete and submit the Magellan Psychological Testing Preauthorization Request Form and submit it online (preferred method), or by fax or mail to the appropriate Magellan Care Management Center for review. An administrative non-authorization will occur if preauthorization is not obtained in routine circumstances.

Each Magellan Care Management Center has its own dedicated fax line for the submission of testing request forms; call the customer service number on the member’s insurance ID card to learn the appropriate fax number. Submitting your request to the incorrect Care Management Center will delay processing.

• Sign in to this website and use the Request Member Care application to enter psychological testing preauthorization requests

• Psychological Testing Preauthorization Request Form (PDF) for handwritten completion

• Psychological Testing Instructions (PDF)

Authorizations and assesments guidance differs by state. If you are providing care to a state-sponsored or government-funded programs, please visit the state-specific Magellan website for details.

• Louisiana

• Pennsylvania

• Virginia 

• Wyoming