Program & Services

Medical Necessity Criteria

Magellan Health Services is committed to the philosophy of providing treatment at the most appropriate, least intensive level of care necessary to provide safe and effective treatment and meet the individual patient's biopsychosocial needs. The Magellan Health Services Medical Necessity Criteria guide both providers and reviewers to the most appropriate level of care for a patient. While these criteria will assign the most safe and effective level of care in nearly all instances, an infrequent number of cases may fall beyond their definition and scope. Decisions regarding treatment are the responsibility of the member or the member's representative and the provider of service.