Interoperability
Information about interoperability and the final rule is available at these links:
- Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization final rule
- General information about interoperability
Magellan must share certain prior authorization data from the previous calendar year with the public each year. See the prior authorization section below for these details and public report. The data along with additional information includes:
- A list of services that require prior authorization.
- Information about prior authorization requests from the previous year.
This CMS final rule also requires Magellan to implement and maintain a secure, standards-based Patient Access Application Programming Interface (API). Magellan’s Patient Access API allows Magellan members to easily access their claims, clinical, and encounter data which is maintained by Magellan and transfer the data to third-party applications selected by the member. See the Patient Access API section below for more educational information including FAQs about privacy and security resources along with a User Guide on how to access the Magellan Health Member Consent Portal.
- List of behavioral health services that are subject to prior authorization
- 2025 Prior Authorization Report – Magellan Behavioral Health of Pennsylvania
- Provider Helpful Tips: Preauthorization Requirements, Medical Policies and Peer-to-Peer Review Procedures
Information coming soon.
The CMS Interoperability and Patient Access final rule required Magellan to implement an API that makes complete and accurate provider directory information available through a public facing digital endpoint on Magellan’s website. This Provider Directory API is available for registered members through a 3rd-party application.