Magellan Health Services

For Providers

Provider Manual

ADHS/DBHS Provider Manual
Magellan Health Services of Arizona Edition

This policy/procedure manual is to be used by Magellan network providers in serving Maricopa County members. Magellan's document follows the guidelines provided by the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS).

Updates to the manual will be detailed in the Provider Notices section of this Web site. Every link on this page, except where noted, links to a PDF and opens a new window. The Adobe Reader is required to view PDF files.

IDTITLEEFFECTIVE DATE
1.0 Scope 03/01/2010
2.0 Introduction 03/01/2010

 

3.0CLINICAL OPERATIONSEFFECTIVE DATE
3.1 Eligibility Screening for AHCCCS Health Insurance, Medicare Part D Prescription Drug Coverage, and the Limited Income Subsidy Program 05/04/2010
3.2 Appointment Standards and Timeliness of Service 09/15/2013
3.3 Referral and Intake Process 04/01/2011
3.4 Co-Payments 02/01/2011
3.5 Third Party Liability and Coordination of Benefits 07/01/2010
3.6 Member Handbooks 02/05/2014
3.7 Reserved
3.8 Outreach, Engagement, Re-Engagement, and Ending an Episode of Care and Disenrollment 12/20/2013
3.9 Assessment and Service Planning 12/20/2013
3.10 SMI Eligibility Determination 1/30/2014
3.11 General and Informed Consent to Treatment 12/01/2013
3.12 Advance Directives 06/15/2013
3.13 Covered Behavioral Health Services 12/20/2013
3.14 Securing Services and Prior Authorization 02/05/2014
3.15 Psychotropic Medications: Prescribing and Monitoring 02/25/2014
3.16 Behavioral Health Drug List 02/05/2014
3.17 Transition of Persons 12/01/2013
3.18 Pre-Petition Screening, Court Ordered Evaluation and Court Ordered Treatment 06/10/2013
3.19 Special Populations 04/01/2011
3.20 Credentialing and Recredentialing 10/01/2012
3.21 Reserved
3.22 Out-of-State Placements for Children and Young Adults 09/15/2013
3.23 Cultural Competence 02/01/2011
3.24 Reserved
3.25 Crisis Intervention Services 05/31/2011
3.26 Housing for Individuals Determined to have a Serious Mental Illness (SMI) 03/01/2013
3.27 Verification of U.S. Citizenship or Lawful Presence for Public Behavioral Health Benefits 02/25/2014

 

4.0COMMUNICATION AND CARE COORDINATIONEFFECTIVE DATE
4.1 Disclosure of Behavioral Health Information 12/01/2010
4.2 Behavioral Health Medical Record Standards 07/01/2012
4.3 Coordination of Care with AHCCCS Health Plans, Primary Care Providers and Medicare Providers  04/26/2012
4.4 Coordination of Care with Other Government Entities 10/15/2013
4.5 Partnerships with Families and Family-Run Organizations in the Children's Behavioral Health System 11/15/2010

 

5.0MEMBER RIGHTS AND PROVIDER CLAIMS DISPUTESEFFECTIVE DATE
5.1 Notice Requirements and Appeal Process for Title XIX and Title XXI Eligible Persons 07/01/2012
5.2 Member Complaints 12/20/2013
5.3 Grievance and Request for Investigation for Persons Determined to Have a Serious Mental Illness (SMI) 08/15/2013
5.4 Special Assistance for Persons Determined to Have a Serious Mental Illness 12/20/2013
5.5 Notice and Appeal Requirements (SMI and Non-SMI/Non-Title XIX/XXI) 08/15/2013
5.6 Provider Claims Disputes 07/01/2012

 

6.0DATA AND BILLING REQUIREMENTSEFFECTIVE DATE
6.1 Submitting Tribal Fee for Service Claims to AHCCCS 09/01/2010
6.2 Submitting Claims and Encounters to the RBHA 09/10/2010

 

7.0REPORTING REQUIREMENTSEFFECTIVE DATE
7.1 Fraud and Program Abuse Reporting 06/15/2013
7.2 Medical Institution Reporting for Medicare Part D 10/15/2013
7.3 Seclusion and Restraint Reporting 09/15/2009
7.4 Reporting of Incidents, Accidents and Deaths 01/15/2010
7.5 Enrollment, Disenrollment and Other Data Submission 02/25/2014
7.6 Duty to Report Abuse, Neglect or Exploitation 02/25/2014
7.7 Duty to Warn 10/01/2012
7.8 Reporting Discovered Violations of Immigration Status 02/25/2014

 

8.0PERIODIC AUDITS AND SURVEYSEFFECTIVE DATE
8.1 Encounter Validation Studies 10/15/2013
8.2 Reserved
8.3 Behavioral Health Recipient Satisfaction Survey 02/25/2014
8.4 Reserved
8.5 Reserved

 

9.0TRAINING AND DEVELOPMENTEFFECTIVE DATE
9.1 Training Requirements 03/01/2013
9.2 Peer Support Training and Certification 10/01/2012

 

10.0T/RBHA-Specific RequirementsEFFECTIVE DATE
10.1

 Provider Referral Process

 Provider Referral - Minumum Required Documents Form

2/10/2014
  Collaborative Protocol Between Magellan Health Services and Arizona Department of Corrections (ADC) 1/1/2014
  Collaborative Protocol Between Magellan Health Services and Arizona Department of Juvenile Corrections (ADJC) 1/6/2014
  Collaborative Protocol Between Magellan Health Services and Child Protective Services (CPS) 12/17/2013
  Collaborative Protocol Between Magellan Health Services and District l of the Division of Developmental Disabilities (DDD) for Adult Consumers 12/17/2013
  Collaborative Protocol Between Magellan Health Services and District I of the Division of Disabilities (DDD) Coordination of Child and Family Team Process 12/17/2013
  Collaborative Protocol Between Magellan Health Services and Maricopa County Juvenile Probation Department (MCJPD) 02/21/2014
  Collaborative Protocol Between Magellan Health Services and Maricopa County Adult Probation Department (MCAPD) 1/1/2014
  Collaborative Protocol Between Magellan Health Services and Rehabilitative Services Administration (RSA) 12/1/2013
               Community Collaboratvie Care Team Referral Form 05/23/2012
  ADHS Minimum Performance Thresholds 04/21/2011
  Maricopa Provider Deliverables 01/06/2010
  Therapeutic Leave Pass and Bed Hold Form 04/15/2008
 

Behavioral Health Assessment  - handwritten  (optional)

Behavioral Health Assessment - electronic (optional)

09/22/2011
  Residential Services Housing Desktop Manual   
 

Magellan Financial Reporting Guide

 

 BLOCK REIMBURSEMENT SCHEDULESEFFECTIVE DATE
  Outpatient Clinic  11/13/2013
  Habilitation Provider  11/13/2013
 

Community Service Agency

Independent Biller

Therapeutic Home

Residential Facility

 11/13/2013

 11/13/2013

 11/13/2013

 11/13/2013

 

IDTITLEEFFECTIVE DATE
11.0 Definitions
12.0 Fact Sheets (Under Construction)
13.0 Forms and Attachments
14.0 Index 09/01/2011



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Confidentiality

Everyone has the right to have personal information kept private. We work hard to protect your privacy. Read more.

Contact Information

Mercy Maricopa Integrated Care (Mercy Maricopa) is now the Regional Behavioral Health Authority (RBHA) serving members in the Maricopa County Region. For questions regarding your services, please call 1-800-564-5465 or TDD/TTY 711.

If you are in crisis, call the Crisis Line at (800) 631-1314, TTY (800) 327-9254. For emergencies, always call 9-1-1.