Magellan Health

For Providers

Medical Necessity Criteria

Magellan Behavioral Health of Pennsylvania is committed to the philosophy of promoting treatment at the most appropriate, least-restrictive level of care needed to effectively meet an individual's biopsychosocial needs. We see the continuum of care as a fluid treatment pathway where individuals may enter treatment at any level and be moved to more or less-intensive settings or levels of care as their changing clinical needs dictate. At any level of care, such treatment is individualized, active and takes into consideration the individual's stage of readiness to change and readiness to participate in treatment.
  • The Pennsylvania Department of Public Welfare (DPW) publishes and maintains behavioral health "Medical Necessity Criteria" for the Pennsylvania HealthChoices program:

 - HEALTHCHOICES BEHAVIORAL HEALTH SERVICES GUIDELINES for MENTAL HEALTH MEDICAL NECESSITY CRITERIA

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Links

Addiction Technology Transfer Center Network

Choose My Plate

COMPASS: CLICK. APPLY. BENEFIT

Eat Right

HealthChoicesPA

MedlinePlus

Million Hearts

NAMI PA

National Council for Community Behavioral Healthcare

National Diabetes Education Program

NIH Senior Health

Pennsylvania Department of Public Welfare

Pennsylvania Department of Health

Philabundance

PROACT

SAMHSA's Wellness Efforts 

Pharmacy Links:

AmeriHealth Caritas

Gateway Health

United Healthcare

Aetna Better Health

UPMC Health Plan

Health Partners

Keystone First

Contact Information

Member Services:
Bucks County: 877-769-9784
Delaware County: 888-207-2911
Lehigh County: 866-238-2311
Montgomery County: 877-769-9782
Northampton County: 866-238-2312

Provider Services:
Bucks/Montgomery: 877-769-9779
Delaware County: 800-686-1356
Lehigh/Northampton: 866-780-3368

Fraud & Abuse: 800-755-0850

For emergency situations always call 911