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Providers Page

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.

Provider Manual

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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Provider Announcements

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

September 14, 2022: Provider Town Hall Recording

August 25, 2022: Telehealth Updates

June 30, 2022: New Email Addresses for ASAM and COE Inquiries

June 6, 2022: EAC RFP Notice

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 NoticeEAC RFPEAC 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

October 9, 2020: Bucks County Virtual Training – Children’s Crisis Diversion and De-Escalation Strategies in the Community Setting

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: RecordingPresentation

May 15, 2020: COVID-19 Update

May 8, 2020: COVID-19 Update

May 1, 2020: COVID-19 Update

Apr. 24, 2020: COVID-19 Update

Apr. 17, 2020: COVID-19 Update

Apr. 10, 2020: COVID-19 Update

Apr. 8, 2020: COVID-19 Update

Apr. 6, 2020: COVID-19 Update

Apr. 3, 2020: COVID-19 Update

COVID-19 FAQ from Magellan – April 2 Edition

COVID-19 Telehealth Memo from Magellan – April 2 Edition

Apr. 1, 2020: COVID-19 Update

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

www.gaincc.org

www.phqscreeners.com

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

Webinar – Screening Tools

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

Program Standards & Requirements (PS&R)

The full PS&R and appendices are available for reviewing on the DHS website.

 

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Compliance Alerts

For additional information on Fraud, Waste, and Abuse, and Compliance click here.

2022 Compliance News

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

June
Treatment/Service Plans

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

Member Newsletters 2022

English

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: 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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PA Member Handbook

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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