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

 

3.0	CLINICAL OPERATIONS	EFFECTIVE 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	09/01/2011
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	07/01/2011
3.6	Member Handbooks	09/01/2011
3.7	Reserved
3.8	Outreach, Engagement, Re-Engagement and Closure	01/09/2012
3.9	Assessment and Service Planning	08/01/2011
3.10	SMI Eligibility Determination	09/14/2007
3.11	General and Informed Consent to Treatment	10/15/2011
3.12	Advance Directives	12/01/2011
3.13	Covered Behavioral Health Services	04/01/2011
3.14	Securing Services and Prior Authorization	05/04/2011
3.15	Psychotropic Medications: Prescribing and Monitoring	03/01/2010
3.16	Medication Formularies	05/31/2011
3.17	Transition of Persons	04/29/2010
3.18	Pre-Petition Screening, Court Ordered Evaluation and Court Ordered Treatment	11/07/2011
3.19	Special Populations	04/01/2011
3.20	Credentialing and Recredentialing	07/15/2010
3.21	Service Package for Non-Title XIX/XXI Persons Determined to Have a Serious Mental Illness (SMI)	04/26/2011
3.22	Out-of-State Placements for Children and Young Adults	12/01/2011
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)	01/01/2011
3.27	Verification of U.S. Citizenship or Lawful Presence for Public Behavioral Health Benefits	06/15/2011

 

4.0	COMMUNICATION AND CARE COORDINATION	EFFECTIVE DATE
4.1	Disclosure of Behavioral Health Information	12/01/2010
4.2	Behavioral Health Medical Record Standards	07/15/2010
4.3	Coordination of Care with AHCCCS Health Plans, Primary Care Providers and Medicare Providers	06/15/2011
4.4	Coordination of Care with Other Government Entities	09/01/2011
4.5	Partnerships with Families and Family-Run Organizations in the Children's Behavioral Health System	11/15/2010

 

5.0	MEMBER RIGHTS AND PROVIDER CLAIMS DISPUTES	EFFECTIVE DATE
5.1	Notice Requirements and Appeal Process for Title XIX and Title XXI Eligible Persons	04/01/2011
5.2	Member Complaints	01/15/2010
5.3	Grievance and Request for Investigation for Persons Determined to Have a Serious Mental Illness (SMI)	05/14/2010
5.4	Special Assistance for Persons Determined to Have a Serious Mental Illness	11/07/2011
5.5	Notice and Appeal Requirements (SMI and Non-SMI/Non-Title XIX/XXI)	05/14/2010
5.6	Provider Claims Disputes	09/15/2009

 

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

 

7.0	REPORTING REQUIREMENTS	EFFECTIVE DATE
7.1	Fraud and Program Abuse Reporting	12/01/2010
7.2	Medical Institution Reporting for Medicare Part D	12/01/2010
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	02/01/2011
7.6	Duty to Report Abuse, Neglect or Exploitation	06/15/2011
7.7	Duty to Warn	03/01/2010
7.8	Reporting Discovered Violations of Immigration Status	06/15/2011

 

8.0	PERIODIC AUDITS AND SURVEYS	EFFECTIVE DATE
8.1	Encounter Validation Studies	07/01/2009
8.2	Reserved
8.3	Behavioral Health Recipient Satisfaction Survey	06/15/2011
8.4	Performance Improvement Projects	12/01/2011
8.5	Medical Care Evaluation Studies	05/31/2011

 

9.0	TRAINING AND DEVELOPMENT	EFFECTIVE DATE
9.1	Training Requirements	07/15/2010

 

10.0	T/RBHA-Specific Requirements	EFFECTIVE DATE
	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)	09/08/2009
	Collaborative Protocol Between Magellan Health Services and Child Protective Services (CPS)	04/08/2009
	Collaborative Protocol Between Magellan Health Services and District l of the Division of Developmental Disabilities (DDD) for Adult Consumers	09/01/2007
	Collaborative Protocol Between Magellan Health Services and District I of the Division of Disabilities (DDD) Coordination of Child and Family Team Process	03/05/2010
	Collaborative Protocol Between Magellan Health Services and Maricopa County Juvenile Probation Department (MCJPD)	02/01/2010
	Collaborative Protocol Between Magellan Health Services and Maricopa County Adult Probation Department (MCAPD)	02/01/2010
	Collaborative Protocol Between Magellan Health Services and Rehabilitative Services Administration (RSA)	10/26/2010
	ADHS Minimum Performance Thresholds	04/21/2011
	Maricopa Provider Deliverables	01/06/2010
	Maricopa Bed Availability Database Process for Providers	10/12/2007
	Therapeutic Leave Pass and Bed Hold Form	04/15/2008
	Behavioral Health Assessment  - handwritten  (optional) Behavioral Health Assessment - electronic (optional)	09/22/2011
	Magellan Financial Reporting Guide
Block Reimbursement Schedules

 

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