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Quality Improvement

Quality Improvement Library

Welcome to the Quality Improvement Library. Here, you will find various resources that Magellan hopes will be beneficial to you. 

Quality Matters at Magellan

Quality care for our members and their families is important to us. We constantly measure the quality of our member services. We are proud of the care that Magellan members receive today. And, we are always looking for ways to make them better.

Quality Improvement at Magellan includes oversight of key program activities, such as:

  1. Accreditations
  2. Care and service monitoring
  3. Clinical decision service tools
  4. Complex case management
  5. Compliments, complaints, grievances and appeals
  6. Core indicator monitoring
  7. Cultural competency
  8. Delegation oversight
  9. HEDIS
  10. Integration
  11. Patient safety
  12. Performance measures and other outcomes
  13. Program documentation
  14. Provider inquiry and review (including quality of care concerns)
  15. Stakeholder experience surveys
  16. Treatment record reviews

Adverse Incident Reporting

As part of Magellan's incident management process, the designation of an incident as a "Sentinel Event" has been added.

This designation will allow for clearer communication between the provider and Magellan so that we can provide timely responses to situations of imminent patient safety concern.

Magellan's definition of a Sentinel Event is consistent with The Joint Commission's 2015 Sentinel Event Policy and Procedures for Behavioral Health Care accredited facilities.

The Adverse Incident form can be found here at the top of Appendix A in our Provider Forms section of the website.

We request that providers call Magellan's Quality Improvement Department at 877-769-9779 if an incident is identified as a Sentinel Event.

Complaints and Grievances

Complaint and Grievance Committee Opportunities

At certain levels of Magellan’s Complaint and Grievance procedures, the review committee making the decision includes a Member (or for reviews involving children, a guardian of a Member). This perspective is extremely valuable in understanding each Member’s concerns and helps shape positive outcomes. If you or someone you know is interested in learning more about this opportunity to serve on this committee, please go here. Questions may be directed to John Bottger, Appeals and Comments Manager, at 215-504-3900.

NCQA

Magellan earned Full MBHO Accreditation through 2023 from the National Committee for Quality Assurance (NCQA).

NCQA is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, managed behavioral healthcare organizations, preferred provider organizations, new health plans, physician organizations, credentials verification organizations, disease management programs and other health-related programs. NCQA reviews include rigorous on-site and off-site evaluations conducted by a team of physicians and managed care experts. A national oversight committee of physicians and behavioral health providers analyzes the team’s findings and assigns an accreditation level based on the MBHO’s performance compared to NCQA standards. NCQA MBHO Accreditation standards are purposely set high to encourage MBHOs to continuously enhance their quality. There are approximately 60 standards for quality included in the following categories: utilization management; credentialing and re-credentialing; members’ rights and responsibilities; and preventive behavioral health care services.

 

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