Magellan Behavioral Health of Pennsylvania (Magellan) welcomes you as a “provider” in HealthChoices and to Magellan. In Pennsylvania, Magellan works with county partners in Bucks, Cambria, Lehigh, Montgomery and Northampton counties. As a Behavioral Health-Managed Care Organization (BH-MCO), Magellan manages members’ benefits in coordination with you – our network providers. This makes it easier for members to get help for their mental health and drug or alcohol concerns.
All of the information and resources available to you are listed below, including provider resources, quality improvement information, county information, our services and programs, and community resources.
The Magellan National Provider Handbook outlines the policies and procedures with which providers are required to comply when serving members whose care is managed by Magellan and/or its affiliated companies.
Providers also must comply with the policies and procedures contained in the Pennsylvania HealthChoices supplement, and any other applicable handbooks, including the National Provider Handbook and the Magellan Organizational Provider Handbook Supplement.
In addition, we encourage you to review the provider orientation presentation. We developed this orientation in collaboration with our providers. We designed it for providers who are new to Magellan; but, it may be a helpful overview for more tenured providers who want to refresh their knowledge of Magellan’s policies and procedures.
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Magellan’s Provider Focus is our e-newsletter for providers. You’ll find current articles and information relating to Magellan and our local service centers. You’ll also find past issues of Provider Focus. Check back as a new issue of our newsletter is released each quarter.
Recent Communications
January 27, 2023: Survey Status Update for Provider Access and Capacity
January 5, 2023: Updates to MNC for Assertive Community Treatment with Continued Stay
January 3, 2023: Return to Prior Authorization Requirements on February 1, 2023
December 21, 2022: Provider Town Hall Recording from December 19
December 21, 2022: 2023 Lehigh Valley Job Fair for Health & Human Services is April 13
December 1, 2022: Availity Learning Center Resources
November 29, 2022: QI Update on Adverse Incident Reporting
October 26, 2022: November 1 Change – Use Availity Essentials to Access HealthChoices Claim Status
October 24, 2022: OMHSAS Reminder of Governor Challenge Training Portal to Prevent Suicide
October 6, 2022: Updated Telehealth FAQ
September 14, 2022: Provider Town Hall Recording
August 25, 2022: Telehealth Updates
June 30, 2022: New Email Addresses for ASAM and COE Inquiries
June 1, 2022: Document Submissions and Requests
May 19, 2022: Information about Public Health Emergency (PHE) and Medical Assistance
May 2, 2022: Telehealth Updates
April 5, 2022: Regulatory Suspensions Extended
March 21, 2022: RFP – Residential Treatment Facility – Adults
February 25, 2022: ASAM Update – 3.7 Level of Care
January 19, 2022: OMHSAS Behavioral Health Telehealth Surveys
January 12, 2022: COBA Notification Update
December 22, 2021: December 17 Provider Town Hall, Powerpoint, Updating Provider Information
December 3, 2021: CMS Interim Final Rule Announcement
November 5, 2021: Survey Reminders for Provider Access and Capacity
October 18, 2021: Magellan’s Updated Telehealth FAQ
October 1, 2021: OMHSAS Update on Telehealth and Regulations – September 30 Announcement
September 30, 2021: Magellan’s Updated Telehealth FAQ
September 10, 2021: Magellan’s Telehealth FAQ
August 31, 2021: Magellan Provider Town Hall
August 27, 2021: OMHSAS Telehealth Update – Bulletin OMHSAS-21-09
August 20, 2021: Waived and Suspended Licensing Regulations
June 15, 2021: Provider Performance Standards are Available on our Website
April 7, 2021: EAC RFP Procurement Notice; EAC RFP; EAC RFP Budget Forms
March 8, 2021: Member Feedback and Substantiated Complaints
February 12, 2021: Update to Prior Authorization Requirements
February 10, 2021: COBA Notification
January 29, 2021: COVID-19 Vaccine Information in Pennsylvania
December 16, 2020: Provider Town Hall
November 24, 2020: A Note of Appreciation for Our Network of Providers
November 19, 2020: COVID-19 Survey Reminders for Providers
September 18, 2020: Magellan Provider Town Hall
July 28, 2020: DHS Announces Redesigned MA ACCESS Cards
July 7, 2020: COVID-19 Provider Announcement
OMHSAS Telehealth Survey for Members
COVID-19 Telehealth Memo From Magellan – May 22 Edition
COVID-19 FAQ From Magellan – May 21 Edition
May 20, 2020 Email: COVID-19 Emergency Change in Authorization Process
Best Practices For Discharge Planning in Family Based Services: Recording, Presentation
Apr. 24, 2020: COVID-19 Update
Apr. 17, 2020: COVID-19 Update
Apr. 10, 2020: COVID-19 Update
COVID-19 FAQ from Magellan – April 2 Edition
COVID-19 Telehealth Memo from Magellan – April 2 Edition
Mar. 30, 2020: COVID-19 Update
Mar. 27, 2020: COVID-19 Update
Mar. 25, 2020: COVID-19 Update
Mar. 23, 2020: COVID-19 Daily Update
Mar. 20, 2020: COVID-19 Daily Update
Mar. 19, 2020: COVID-19 Daily Update
Mar. 18, 2020: COVID-19 Daily Update
Mar. 17, 2020: COVID-19 Daily Update
Mar. 16, 2020: COVID-19 Daily Update
Mar. 13, 2020: COVID-19 Updates
Mar. 11, 2020: COVID-19 Provider Email
Jan. 17, 2020: IBHS/BHRS transitional authorization process for current BHRS/ABA providers
Oct. 22, 2019 Provider Town Hall in Cambria County
Sept. 5-6, 2019 Provider Town Halls in Eagleville, Allentown
July 31, 2019: All Inclusive and Exclusive Contract Language
July 22, 2019: Modification to Approved Training on ASAM Criteria
Tobacco Dependence Treatment Training
Certified Peer Support Announcement
Certified Peer Support Certification Announcement
Certified Peer Support Grandparenting Application 3.1.18- 8.31.19
Medication-Assisted Treatment (MAT)
As the opioid epidemic and other substance usage continues to affect millions of lives in the United States, every treatment option should be taken into consideration to potentially save a life. Medication-assisted treatment (MAT) offers protection against overdosing, prevents injection behaviors, reduces criminal behavior, and reduces overall drug utilization. Magellan has prepared a power point for providers outlining general concepts for this important treatment option consideration.
Provider Screening Tools
Magellan launched its screening programs to target individuals who may have co-occurring mental health and substance use disorders, as well as a brief screening tool for depression. Magellan chose the following screening tools:
The Global Appraisal of Individual Needs-Short Screener (GAIN-SS) | Short Screener Description
The Patient Health Questionnaire two-item scale (PHQ-2) | Questionnaire Description
The GAIN-SS is a brief five minute instrument designed to quickly and accurately screen general populations of both adults and adolescents to detect psychiatric disorders, substance use disorders, or crime and violence problems. The screener helps identify those who would benefit from further assessment or referral for these issues, and also rules out those who do not have a behavioral health disorder.
The PHQ-2 consists of the first two items from the longer Patient Health Questionnaire-9, which consists of nine items that align with the DSM criteria for major depression. The PHQ-2 inquires about the frequency of depressed mood and loss of pleasure or interest over the past 2 weeks. Its purpose is not to establish a final diagnosis but to screen for depression as an initial approach. A PHQ-2 score ranges from 0-6, with recommendations for further screening with a PHQ-9 for anyone scoring a 3 and above.
Screening tool access
The screening tools are of use to identify any member suspected of possibly having a depressive disorder and/or individuals with a mental illness who could also potentially have a substance use disorder. It is recommended that these tools be utilized for every potential candidate on initial evaluation and at least on a quarterly basis.
Webinar access
Magellan created a provider webinar to teach providers about Magellan’s screening tool program and how to utilize the tools selected. The webinar training covered the following:
- Purpose of the program
- Identify the targeted population for the tools
- Descriptions of the tools selected
- Benefits of using the screening tools
A Practitioner’s Resource Guide: Helping Families to Support their LGBT Children
Compliance News
Magellan strives on being proactive and to use education as a preventative tool to provide our members the highest quality of care through you, the provider. The Quality Improvement and Compliance Departments at Magellan have committed to sending monthly e-mails to targeted providers on a Compliance related subject. Click here to view our Monthly Compliance Alerts.
Training/Webinar Alerts
- ABA Services Webinar Recording – April 2017
- ABA Services Webinar – Question & Answer – April 25, 2017
- ABA Services Overview – April 25, 2017
- Exploring ABA – April 10, 2018
Program Standards & Requirements (PS&R)
The full PS&R and appendices are available for reviewing on the DHS website.
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For additional information on Fraud, Waste, and Abuse, and Compliance click here.
2023 Compliance News
January
Telehealth and Signature Requirements
2022 Compliance News
December
Compliance 2022 Year in Review
November
Compliance Forum and Updated Telehealth Resources
October
Partial Hospital Billing and Regulatory Reminders
September
Registration for Magellan’s Annual Compliance Forum
August
Provider Self-Audits and Self-Reports of Fraud, Waste and Abuse
July
Magellan Annual Compliance Forum: Save the Date and Provider Survey
June
Outpatient Regulations for Group Size
May
Performance/Outcome Management System (POMS)
April
Compliance and Fraud, Waste & Abuse Resources
March
Medication Assisted Treatment in Substance Use Disorder Residential Programs
February
Substance Use Disorder Case Management Services Reminders
January
Assertive Community Treatment (ACT) Compliance and Regulatory Reminders
2021 Compliance News
December
Compliance 2021 Year in Review
November
Psychiatric Outpatient Clinic Chapter 5200 Compliance Guide
October
Compliance Forum Resources and Updated Telehealth FAQ
September
Crisis Plan Expectations
August
Registration for Annual Compliance Forum
July
Methadone Maintenance Access in Residential Treatment
June
ASAM Alignment Update & Extension Requests
May
Treatment/Service Plan Requirements
April
Maintaining Active Licensure and MA Enrollment
March
ASAM Alignment
February
Telehealth Guidelines during COVID-19
January
Provider Self-Monitoring and Subsequent Self-Reports/Self-Disclosures of Fraud, Waste or Abuse (FWA)
2020 Compliance News
December
Compliance 2020 Year in Review
November
2020 Provider Compliance Forum and OMHSAS PHE Regulations Update
October
Peer Run Organizations
September
OMHSAS Memo Regarding “Public Health Emergency
August
Electronic Health Records
July
Encounter Forms
June
Collaborative Documentation
May
Requirement to Report Changes in Licensure
April
Provider Self-Reports of Fraud, Waste or Abuse
March
Per Diem Substance Abuse Facility Documentation Requirements
February
Interpreter Services
January
Updated Peer Support Services Bulletin and Provider Handbook
2019 Compliance News
December
Compliance Year in Review – 2019
November
CRNP, PA, & RN Services in Outpatient Clinics
October
Updated Outpatient Regulations
September
Billable Unit Definitions and Rounding Up
August
Per Diem Provider Contracts
July
Upcoding and Billing in Accordance With Your Magellan Reimbursement Schedule
June
Exclusion Monitoring/Screening Requirements
May
Targeted Case Management Compliance and Regulatory Reminders
April
RTF Bed Hold and Therapeutic Leave
March
Compliance Reminders for ABA Providers
February
Provider Self Reports and Self Disclosures of FWA
January
Peer Support Services
2018 Compliance News
December
Compliance Year in Review – 2018
November
Annual Compliance Training
October
Outpatient Psychiatric Oversight Act
September
Encounter Forms
August
RTF Bed Hold and Therapeutic Leave Guidelines
July
Reminder about Minimum Documentation Requirements
June
Patrial Hospital Billing and Regulatory Issues
May
Billing for multiple approved service locations
April
Certified Peer Specialist Certification
March
Provider Self-Audits and Self-Reports of FWA
February
Billing of Individual and Family Psychotherapy
January
D&A Narcotic Treatment Programs, Drug Testing, and Laboratory Services
2017 Compliance News
December
Compliance Year in Review 2017
November
Compliance Forum Resources
Compliance Forum 2017
October
Updated Peer Support FAQs and Changes to Eligibility Criteria
Peer Support Services Provider Handbook
Peer Support Services FAQ Document
Peer Support Services Update – MA Bulletin OMHSAS-16-12
September
Treatment and Service Plans
August
TSS Supervision
July
Electronic Health Records and Maintaining Compliance
Collaborative Documentation Cover Letter and Guidelines
June
Compliance Forum Planning Survey
May
Responsibility of Payment for Medication-Assisted Treatment Services (MAT)
Responsibility of Payment for Medication-Assisted Treatment Services (MAT) for
Individuals with Opiate Use Disorder (OUD)
April
Documentation and Billing for Neuropsychological Testing
March
Billing for Travel & Transportation in Peer Support and Case Management Services
February
Documentation of Start and End Times on Progress Notes
January
Provider Self-Audits and Self-Reports of FWA
Provider Self Disclosure Claims Recovery Template
2016 Compliance News
December
Compliance Notebook’s Year in Review
November
Certified Peer Support Training Requirements
Provider Handbook – Psychiatric & Partial Hospitalization Services
October
Outpatient Group Therapy & Structured Breaks
September
Compliance Resources
Compliance Forum 2016 – Fraud, Waste & Abuse Prevention & Monitoring
Medicaid Fraud Control Section – Neglect of Care-Dependent Person Unit
August
Family-Based Services Family Support Funds
July
Billing for No-Shows & Holding Members Harmless
Missed Appointments & No-Shows Charges
May
Outpatient Regulations for Group Size
PA Code: Outpatient D&A Clinic Regulations – Chapter 1223
PA Code: Outpatient Psychiatric Services Regulations – Chapter 1153
April
CRNP Services in Outpatient Clinics
March
TSS Training & Supervision for ABA
Training & Supervision Requirement for TSS Workers
Training & Supervision Requirements for TSS Workers – FAQ Guide
February
Provider Self-Reports of Fraud, Waste & Abuse
Provider Self Disclosure Claims Recovery Template
January
Educational Requirements for Behavioral Specialist Consultant Services
2015 Compliance News
December
Compliance 2015 – Year in Review
November
Interpreter Services
Interpreter Services Policy Clarification
October
Mobile Therapy – Mandatory Meeting
September
Changes impacting Background Clearances for staff
August
Family-Based Services Family Support Funds
Family-Based Services PA Bulletin
The Family Based Mental Health Services Program – Appendix T
July
Peer Support Training on Collaborative Documentation
Documentation Training including CD
Progress Note Sample with CD Check-Off
June
Guidance for BSC’s Attending Evaluation
May
Case Management & Peer Support Eligibility Criteria
SMI & Adult Priority Group MA Bulletin – March 1994
April
Mandatory Reporting
Community Incident Management & Reporting
Mandatory Report Form
Informational Guidance Mandatory Reporting
Mandatory Report Form Instructions
March
Provider Self-Reports of Fraud, Waste, & Abuse
Provider Self Disclosure Claims Recovery
February
DSM-5 & ICD-10 Resources
Diagnostic & Statistical Manual of Mental Disorders
January
Outpatient Group Therapy
Travel in Certified Peer Support (CPS) and CRS Services
2014 Compliance News
December
The Year in Review
November
Provider Manual Update
October
Website Enhancements
September
Reporting Changes in Licensure
August
Psychiatric Diagnostic Evaluations (90791) Billing
July
Rounding Up of Billable Units
ICM Regulations
Billing for Units of Service based on periods of time and rounding MA Bulletin
Billing for Units of Service based on periods of time and rounding MA Bulletin & FBS Exemption
Crisis Intervention Services Regulations
June
D&A Lab Services
Payment for Diagnostic Laboratory Services in Outpatient Drug & Alcohol Clinics
Medical Assistance Payment for Certain Diagnostic Laboratory Services
May
Self-Disclosures
Template – Provider Self Disclosure Claims Recovery
April
Collaborative Documentation
Compensation & Progress Notes
March
Partial Hospital Group Services
Group Therapy in Partial Hospitalization – Policy Clarification
Group Psychotherapy in Partial Hospitalization – Policy Clarification
February
Release of New MA Bulletins ‘listserv’ Option
January
Policy Change on Signed Encounter Verification Forms
Encounter Verification Policy Change – Provider Attestation Form
2013 Compliance News
December
2013 Year in Review and PA Website
November
Outpatient Individual & Family Therapy
CMS 1500 Provider Disclaimer
October
Community Treatment Teams (CTT) & Assertive Community Treatment (ACT)
Assertive Community Treatment (ACT) National Program Standards
Assertive Community Treatment (ACT) Standards – MA Bulletin
Community Treatment Team (CTT) Medical Necessity Criteria – Magellan
September
Family-Based Mental Health Services Policy Clarification
FBMHS Policy Clarification
August
OMHSAS LGBQI Regulations
LGBTQI Nondiscrimination MA Bulletin
LGBTQI Affirmative Environments MA Bulletin
July
Waste & Abuse
June
Psychiatric Rehabilitation Services
PA Code – Psych Rehab Regulations
Psychiatric Rehab Medical Necessity Criteria
Psych Rehab Regulations
May
BHRS Psychological Evaluations
SM PA BHRS Contract Update Amendment Cover Letter
Life Domain Guidelines
April
D&A Outpatient Clinic Regulations
PA Code – Outpatient D&A Clinic Regulations – Chapter 1223
DDAP – D&A Services – Dating of Signatures
MA Bulletin – Billing for Units of Services Based on Periods of Time
MA Bulletin – D&A – Outpatient Clinic – Medication Management Visit
March
Medical Assistance Provider Self-Audit Protocol
MA Provider Self-Audit Protocol
February
Pennsylvania Regulations & Bulletins for Targeted Case Management
TCM Travel Bulletin
MA Bulletin TCM Documentation
Chapter 5221 ICM
County Administration- MCOs – TCM Program
TCM Refresher Training
January
Family-Based Mental Health Regulations – Chapter 5260
Member Newsletters 2023
English
Member Newsletter: Know the risks of marijuana – Winter 2023
Spanish
Boletin para el miembro: Conozca los riesgos de la marihuana – Invierno 2023
Member Newsletters 2022
English
Member Newsletter: Find help with food resources – Fall 2022
Member Newsletter: July is BIPOC Mental Health Awareness Month – Summer 2022
Member Newsletter: Stress awareness can help you get through challenges – Spring 2022
Member Newsletter: An Overview of Community Support Programs and Member Focused Agencies – Winter 2022
Spanish
Boletin para el miembro: Cómo encontrar ayuda con los recursos alimentarios – Otono 2022
Boletin para el miembro: Julio es el Mes de Concientizacio sobre la Salud Mental de BIPOC – Verano 2022
Boletin para el miembro: La concientizacion sobre al estres puede ayudarlo a supercar los desafios – Primavera 2022
Boletin para el miembro: Una Vision General de los Programas de Apoyo a la Comunidad y Agencias Enfocadas a los Miembros – Invierno 2022
Member Newsletters 2021
English
Member Newsletter: Telehealth Services Update – Fall 2021
Member Newsletter: Older Adults Need to Create Intergenerational Connections – Summer 2021
Member Newsletter: Young Adults: It’s Okay to Ask for Help – Spring 2021
Spanish
Boletin para el miembro: Actualizacion de Servicios de Telesalud – Otono 2021
Boletin para el miembro: Los Adultos Mayores Necesitan Crear Conexiones Intergeneracionales – Verano 2021
Boletin para el miembro: Adultos jovenes: Esta Bien pedir ayuda – Primavera 2021
Member Newsletters 2020
English
Member Newsletter: Virtual Benefits for Certified Peer Support (CPS) and Certified Recovery Support (CRS) – Winter 2020
Member Newsletter: Wellness and Self-Care Tips During COVID-19 – Fall 2020
Member Newsletter: Helpful Resources for Families During COVID-19 – Summer 2020
Member Newsletter: Vaping/E-cigarette Use is Dangerous for Youth and Many Adults – Spring 2020
Spanish
Boletin para el miembro: Beneficios virtuales para el apoyo de pares certificado (CPS) y el apoyo de recuperacion certificado (CRS) – Invierno 2020
Boletin para el miembro: Consejos de bienestar y cuidado personal durante la COVID-19 – Otono 2020
Boletin para el miembro: Recursos utiles para las familias durante el COVID-19 – Verano 2020
Boletin para el miembro: El uso de vapeo/e-cigarrilloes peligroso para los jovenes y muchos adultos – Primavera 2020
Member Newsletters 2019
English
Member Newsletter: Intensive Behavioral Health Services (IBHS) Starts in January
Member Newsletter: Crisis Teams are Available For You – Fall 2019
Member Newsletter: Searching for Specialty Providers On Our Website – Summer 2019
Member Newsletter: Social Determinants of Health Resources Are Available – Spring 2019
Spanish
Boletin para el miembro: A partir de enero, comienzan los servicios intensivos de salud conductual (IBHS)
Boletin para el miembro: Los equipos de crisis estan disponibles para usted – Otono 2019
Boletin para el miembro: Como buscar proveedores de especialidades en nuestro sitio web – Verano 2019
Boletin para el miembro: Hay disponibles determinantes sociales de recursos de salud – Primavera 2019
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We encourage members to make the best use of their HealthChoices plan. The member handbook includes details about benefits and other helpful information:
PA Member Handbook (English)
PA Member Handbook – Bucks, Cambria, Lehigh, Montgomery, and Northampton Counties
Spanish Version of PA Member Handbook (Espanol)
Manual para miembros – Bucks, Cambria, Lehigh, Montgomery, and Northampton Counties
Note: The member handbooks are available in paper form without charge, upon request.
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Get connected with Magellan resources.
Learn about best practices to improve the quality of services.
Get connected with your local county resources.
Learn about all of the services and programs offered through Magellan.
There are many opportunities available to help you live a healthy, vibrant lifestyle.