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Transition

Authorizing Services Provided Prior to December 1, 2015

Authorizations for service are as follows:

 

  • While Magellan is no longer financially responsible for claims payment for services provided after November 30, 2015, four types of 24-hour behavioral health services will be authorized and paid by Magellan for those members in treatment at midnight on November 30, 2015, as indicated:
    • Non-ambulatory detox services as authorized through December 6, 2015 or the first concurrent review after November 30, 2015, whichever comes first.
    • Inpatient psychiatric services as authorized through December 7, 2015 or the first concurrent review after November 30, 2015, whichever comes first. 
    • Substance use residential (ASAM Levels 3.1, 3.3, 3.5, 3.7 and 3.7D) services as authorized through December 13, 2015 or the first concurrent review after November 30, 2015, whichever comes first.
    • Psychiatric Residential Treatment and Therapeutic Group Home services as authorized through December 13, 2015 or the first concurrent review after November 30, 2015, whichever comes first.

 

 NOTE: For the above four types of services only, Magellan will conduct a concurrent review at the expiration of the Magellan authorization (even though this occurs past November 30). This concurrent review determination that occurs in December will be provided to the Bayou Health Plan and is no longer the financial responsibility of Magellan.  (This information will be communicated to the health plans through DHH to allow the Bayou Health Plans to utilize this authorization if they choose.)

 

  • All authorizations issued by Magellan for any other services outside of the above mentioned 24-hour services are only payable by Magellan through November 30, 2015. Guidance will be provided by DHH or the Bayou Health Plans on the authorization process after November 30, 2015.
  • Clinical Appeals (member appeals) will be accepted by Magellan after November 30, 2015, for dates of service up to November 30, 2015.
    • Member appeals by phone will be accepted through December 16, 2015.
    • Member appeals by fax, email or mail will be accepted through February 29, 2016.
    • No changes are made to the current appeals guidelines. Please refer to  Magellan’s  Provider Handbook, Section 4.5.
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