What’s on this page

Initiating Care

Authorization is the process of obtaining pre-authorization to provide a service deemed special or non-standard.
What’s on this page

Authorization

Magellan bases authorization on a thorough assessment of the member's unique needs. We seek the least intruisive treatment, most appropriate treatment that may be administers in a timly and efficient manner.

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.

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.

Instructions for EAP Initial Session Documentation

Each client of adult age receiving services must sign a Statement of Understanding (SOU) indicating that they understand the nature of EAP services. For minors, a parent or legal guardian must sign the SOU, unless under applicable state law a minor can consent to treatment. A copy of the signed SOU is to be offered to the client. Use the company-specific SOU which is available in the online EAP Registration packet. Note: The Federal Occupational Health (FOH) EAP uses a custom Statement of Understanding, see page 14 of the FOH supplement appendix (PDF).

  • Client Information Form (PDF)
    This form is to be completed by the client.

  • Clinical Assessment (PDF)
    All clients age 12 and older are to be assessed for alcohol and other drug use, risk factors, and job/school impact. Include a risk assessment in the clinical assessment.

  • Counseling Plan (PDF)
    Initiate this form during the first session based on the clinical assessment.

Get More Outpatient Authorizations (only if required by plan)

Note that most plans Magellan manages do not require authorization for routine outpatient services; call the number on the member's benefit card if you have questions about plan requirements.

Our online Treatment Request Form (TRF) is designed to process requests for additional outpatient behavioral healthcare services for members whose plans require authorization for outpatient care. If you have not obtained an authorization for the care you currently are providing, you will not be able to use the TRF to request additional sessions.

Instructions for Use

Online TRF is used for concurrent authorization requests only. It cannot be used to request an initial authorization. If you have not obtained an authorization for the care you are currently providing, you will not be able to use Online TRF to request additional sessions. Please call the applicable Magellan Care Management Center for assistance. To complete the Online TRF:

Enter the prior authorization number exactly as it appears on your most recent authorization letter, paying particular attention to upper and lower case, and punctuation.

When the authorization number you entered is validated, the Initiate Authorization Request screen will be displayed. Follow the instructions in the application to complete this page.

  1. You will need to successfully submit one TRF online before entering another one.

  2. If you exit your browser before successfully submitting your request, your data will be lost.

  3. You will not be able to complete a successful submission after you've closed the browser or moved on to request additional sessions for other members in care.

  4. If you have questions that are not answered in this application, email us at InternetTRF@Magellanhealth.com.

Medical Necessity

Effective Nov. 18, 2023 all plans use the 2023-2024 Magellan Care Guidelines unless noted in the State/Client-Specific Criteria section below.

Magellan Care Guidelines (MCG)
The Magellan Care Guidelines (MCG) are designed to decide the medical necessity and clinical appropriateness of health services.
Magellan cultivates its own proprietary clinical criteria, which are used as our primary decision support mechanism for our Utilization Management Program. 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.  These guidelines are made publicly available.

 

The 2023-2024 Magellan Care Guidelines (PDF) include:
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.

Review a summary of changes (PDF) to the 2023-2024 Magellan Care Guidelines.

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Assessment

Delivering quality care starts with an accurate and thorough assessment of the member’s needs. Depending on the benefit plan, an assessment may be conducted by our care management team before making a referral or by you during the member’s visit.

For members presenting for services other than routine outpatient, as a provider you should conduct a thorough assessment and be prepared to provide that to Magellan. An assessment should include symptoms, event(s) precipitating the call, potential harm to self or others, treatment history, etc. You may be asked to fax a thorough assessment of the member to Magellan in lieu of providing verbal assessment over the phone.

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

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.

Member Rights

Magellan believes in protecting all member’s rights to receiving care delivered with dignity, and respect. Our official statement is published and downloadable in the appendix of our National Provider Handbook. 

Members' rights and responsibilities apply whether services are provided virtually or in-person.  

Download a copy of Magellan’s Members’ Rights and Responsibilities Statement. Review the statement with members in your care at their first appointment. Both you and the member should sign it. Retain a copy of the signed copy in the member’s record. 

We recommend that you also inform the members in your care of the procedures to follow if a clinical emergency occurs, confidentiality scope and limits, treatment options, etc. Take the opportunity to obtain consent to share information with their primary care physicians or other providers; this will improve the efficiency of coordinating care. 

Magellan supports culturally sensitive care that respects the member’s cultural beliefs, practices and language preferences.

As you collaborate with us, we will ask you to employ current best practices in providing culturally competent care for our members. The following external resources will aid you (and us) in developing realistic and incremental organizational cultural competence plans.

Locate our policies related to cultural competency in section 4 on page 49 of the Magellan National Provider Handbook.

Cultural Competency

Magellan supports culturally sensitive care that respects the member’s cultural beliefs, practices and language preferences.

As you collaborate with us, we will ask you to employ current best practices in providing culturally competent care for our members. The following external resources will aid you (and us) in developing realistic and incremental organizational cultural competence plans.
  • National CLAS Standards
  • Georgetown University National Center for Cultural Competence
  • National Center for Cultural Competence Self-assessments
  • Cultural Competency in Mental Health Peer-run Programs and Self-help Groups
Locate our policies related to cultural competency in the Magellan National Provider Handbook (PDF), section 4.

Black, Indigenous and People of Color (BIPOC) mental health awareness
  • Magellan resources for BIPOC Mental Health Awareness Month (July)
  • BIPOC mental health awareness Q & A with Magellan clinical director Rakel Beall-Wilkins, MD, MPH
  • Magellan supports BIPOC mental health with these tips from clinical director Misty Tu, MD
  • BIPOC mental health awareness tip sheets (can be shared with members)