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.

ID	TITLE
1.0	Scope
2.0	Introduction

 

3.0	CLINICAL OPERATIONS
3.1	Eligibility Screening for AHCCCS Health Insurance, Medicare Part D Prescription Drug Coverage, and the Limited Income Subsidy Program
3.2	Appointment Standards and Timeliness of Service
3.3	Referral Process
3.4	Co-Payments
3.5	Third Party Liability and Coordination of Benefits
3.6	Member Handbooks
3.7	Clinical Liaison
3.8	Outreach, Engagement, Re-Engagement and Closure
3.9	Intake, Assessment and Service Planning
3.10	SMI Eligibility Determination
3.11	General and Informed Consent to Treatment
3.12	Advance Directives
3.13	Covered Services
3.14	Securing Services and Prior Authorization
3.15	Psychotropic Medications: Prescribing and Monitoring
3.16	Medication Formulary
3.17	Transition of Persons
3.18	Pre-Petition Screening, Court Ordered Evaluation and Treatment
3.19	Special Populations
3.20	Credentialing and Privileging
3.21	Service Prioritization for Non-Title XIX/XXI Funding
3.22	Out-of-State Placements for Children and Young Adults
3.23	Cultural Competence

 

4.0	COMMUNICATION AND CARE COORDINATION
4.1	Disclosure of Behavioral Health Information
4.2	Behavioral Health Medical Record Standards
4.3	Coordination of Care with AHCCCS Health Plans and Primary Care Providers
4.4	Coordination of Care with Other Government Entities

 

5.0	MEMBER RIGHTS AND PROVIDER CLAIMS DISPUTES
5.1	Notice Requirements and Appeal Process for Title XIX and Title XXI Eligible Persons
5.2	Member Complaints
5.3	Grievance and Request for Investigation for Persons Determined to Have a Serious Mental Illness (SMI)
5.4	Special Assistance for SMI Members
5.5	Notice and Appeal Requirements (SMI and Non-SMI/Non-Title XIX/XXI)
5.6	Provider Claims Disputes

 

6.0	DATA AND BILLING REQUIREMENTS
6.1	Submitting Tribal Fee for Service Claims to AHCCCS
6.2	Submitting Claims and Encounters to the RBHA

 

7.0	REPORTING REQUIREMENTS
7.1	Fraud and Program Abuse Reporting
7.2	Institutions for Mental Disease (IMD) Reporting
7.3	Seclusion and Restraint Reporting
7.4	Reporting of Incidents, Accidents and Deaths
7.5	Enrollment, Disenrollment and Other Data Submission
7.6	Duty to Report Abuse, Neglect or Exploitation

 

8.0	PERIODIC AUDITS AND SURVEYS
8.1	Encounter Validation Studies
8.2	Reserved
8.3	Consumer and Family Satisfaction Survey
8.4	Performance Improvement Projects
8.5	Medical Care Evaluation Studies

 

9.0	TRAINING AND DEVELOPMENT
9.1	Training Requirements

 

10.0	T/RBHA-Specific Requirements
	Collaborative Protocol Between Magellan Health Services and Arizona Department of Corrections (ADC)
	Collaborative Protocol Between Magellan Health Services and Arizona Department of Juvenile Corrections (ADJC)
	Collaborative Protocol Between Magellan Health Services and Child Protective Services (CPS)
	Collaborative Protocol Between Magellan Health Services and District l of the Division of Developmental Disabilities (DDD) for Adult Consumers
	Collaborative Protocol Between Magellan Health Services and District I of the Division of Disabilities (DDD) Coordination of Child and Family Team Process
	Collaborative Protocol Between Magellan Health Services and Maricopa County Juvenile Probation Department (MCJPD)
	Collaborative Protocol Between Magellan Health Services and Rehabilitative Services Administration (RSA)
	ADHS Minimum Performance Thresholds
	Maricopa Provider Deliverables
	Maricopa Bed Availability Database Process for Providers
	Maricopa Outpatient Appt. Availability Database Process for Providers
	Therapeutic Leave Pass and Bed Hold Form
	Magellan Health Services of Arizona, Inc. Provider Financial Reporting Guide
Reimbursement Schedules

 

ID	TITLE
11.0	Definitions
12.0	Fact Sheets (Under Construction)
13.0	Forms and Attachments
14.0	Index