Clinical Guidelines - Provider Portal
What’s on this page
Clinical Guidelines
Discover clinical tools and protocols that are essential to delivering high quality care to your Magellan members.
What’s on this page
Clinical Monographs
Magellan develops clinical monographs, which are informative papers designed to share important research and analysis of issues relevant to behavioral health practitioners.
Appropriate Use of Psychotropic Drugs in Children and Adolescents (PDF),
monograph summary (PDF), and
Evidence-based Practices in Drug and Alcohol Treatment and Recovery (PDF)
Understanding and Meeting the Needs of Children and Adolescents at High Risk: Foundations of a Model (PDF), and
monograph summary (PDF)
As always, we welcome your feedback and suggestions on our clinical monographs and practice guidelines. Email us at CPG@MagellanHealth.com.
Practice Guidelines
Acute Stress Disorder & Post-Traumatic Stress Disorder
ADHD
Depression
Managing Suicidal Patients
Schizophrenia
Autism
Visit our comprehensive page on providing care for Autism Services
Substance Abuse
Visit our comprehensive page on Substance Use Treatment Care.
Clinical Practice Guidelines
Magellan's clincal practice guidelines assist in screening, assessing and treating common disorders. Prior to adopting each guideline, a multi-disciplinary panel —including board-certified psychiatrists and clinical staff — examines pertinent scientific literature and gathers input from network providers in addition to consumers and community agencies.
Magellan revisits practice guidelines regularly, reviewing each guide at least every two years to gauge suitability. Guideline changes publish to our online newsletter, Provider Focus. We also encourage you to periodically return to this webpage for updates.
Magellan’s adopted guidelines are intended to augment, not replace, sound clinical judgment. We welcome your feedback and will consider all suggestions and recommendations in our next review. You may submit comments to your regional Magellan provider advisory group, medical director or to CPG@MagellanHealth.com.
Magellan develops or adopts clinical practice guidelines to assist providers in screening, assessing and treating common disorders. Prior to adopting each guideline, a multi-disciplinary panel—including board-certified psychiatrists and clinical staff—examines relevant scientific literature and seeks input from network providers as well as consumers and community agencies. Once implemented, Magellan reviews each guideline at least every two years for continued applicability and updates guidelines as necessary. We report guideline changes through our online newsletter, Provider Focus. We also encourage you to periodically return to this webpage for updates.
Magellan’s adopted guidelines are intended to augment, not replace, sound clinical judgment. We welcome your feedback and will consider all suggestions and recommendations in our next review. You may submit comments to your regional Magellan provider advisory group, medical director or to CPG@MagellanHealth.com.
Acute Stress Disorder & Post-Traumatic Stress Disorder
ADHD
Depression
Managing Suicidal Patients
Schizophrenia
Autism
Visit our comprehensive page on providing care for Autism Services
Substance Abuse
Visit our comprehensive page on Substance Use Treatment Care.
Medical Necessity Criteria
Magellan uses Milliman Care Guidelines (MCG), along with our proprietary clinical criteria, Magellan Healthcare Guidelines, as the primary decision support tools for our Utilization Management Program. Collectively, they are known as the Magellan Care Guidelines.
Effective Nov. 18, 2023 all plans use the 2023-2024 Magellan Care Guidelines unless noted in the State/Client-Specific Criteria section below.
All guidelines meet federal, state, industry accreditation, and customer contract requirements. They are based on sound scientific evidence for recognized settings of behavioral health services and are designed to decide the medical necessity and clinical appropriateness of services.
These guidelines are proprietary to MCG Health. To view a copy of a guideline associated with a member’s clinical review, contact Magellan at the number on the member’s benefit card, and a representative will send you a copy or grant you special online access.
Medical Necessity Criteria (effective Nov. 18, 2023):
2023-2024 Magellan Care Guidelines (PDF)
- If you need to look back at last year's Guidelines you may download a copy of the 2022-2023 Magellan Care Guidelines (PDF).
- For a summary of the changes to the 2022 MCG Guidelines we have provided a MCG Summary of Revisions (PDF).
Providers must meet the specified requirements for treatment of Major Depression using Transcranial Magnetic Stimulation (TMS).
Transcranial Magnetic Stimulation (TMS) Privileging Criteria (PDF)
Coverage for TMS and other services are based on member’s benefit plan.
Specific state laws and client requirements may demand modified medical necessity criteria. If you have members in care under any of the benefit plans, in any of the states, or employed by any of the employers requiring modified criteria, please refer to the appropriate medical necessity criteria below. For more information on the use of the below criteria, contact the medical director at your Magellan Care Management Center.
- American Society of Addiction Medicine (ASAM)
- An Introduction to The ASAM Criteria for Patients and Families (PDF)
Licensee's use and interpretation of the American Society of Addiction Medicine’s ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits.
California |
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Louisiana |
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New Mexico |
New Mexico Prior Authorization Requirements and Clinical Criteria |
Pennsylvania |
Pennsylvania HealthChoices – criteria for providers serving members of the HealthChoices Program in Pennsylvania can be found at www.MagellanofPA.com. |
Texas |
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Virginia |
Practice Guidelines
Acute Stress Disorder & Post-Traumatic Stress Disorder
ADHD
Depression
Managing Suicidal Patients
Schizophrenia
Autism
Visit our comprehensive page on providing care for Autism Services
Substance Abuse
Visit our comprehensive page on Substance Use Treatment Care.
Prescribing Guidelines
You can find Magellan's clinical practice guideline audit tools in the National Provider Handbook Appendix A.
Practice Guidelines
Acute Stress Disorder & Post-Traumatic Stress Disorder
ADHD
Depression
Managing Suicidal Patients
Schizophrenia
Autism
Visit our comprehensive page on providing care for Autism Services
Substance Abuse
Visit our comprehensive page on Substance Use Treatment Care.
Psychological Testing
Psychological testing is defined as the use of one or more standardized measurements, instruments or procedures to observe or record human behavior, and requires the application of appropriate normative data for interpretation or classification. 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.
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
Practice Guidelines
Acute Stress Disorder & Post-Traumatic Stress Disorder
ADHD
Depression
Managing Suicidal Patients
Schizophrenia
Autism
Visit our comprehensive page on providing care for Autism Services
Substance Abuse
Visit our comprehensive page on Substance Use Treatment Care.
Aftercare Appointments
One of the best things we can do for a member who has experienced a psychiatric/substance abuse hospitalization is to ensure they have and keep an aftercare appointment with a behavioral health provider -- preferably within seven days -- but may occur within 30 days of discharge. This important step contributes to aftercare compliance and helps prevent readmissions.
Facilities and outpatient providers play a vital role in helping members receive timely ambulatory follow-up appointments after hospitalization from an acute care setting.
Facilities: Including these elements in your discharge planning (PDF) can help ensure members receive the services they need
Outpatient provider: Helping patients receive timely ambulatory follow-up with these tips (PDF) can result in more successful outcomes (includes coding guide)
Improving care after hospitalization for mental illness: slide deck (PDF)
Practice Guidelines
Acute Stress Disorder & Post-Traumatic Stress Disorder
ADHD
Depression
Managing Suicidal Patients
Schizophrenia
Autism
Visit our comprehensive page on providing care for Autism Services
Substance Abuse
Visit our comprehensive page on Substance Use Treatment Care.