region/plan-specific news : California

Providers demonstrate strong adherence to treatment record and clinical practice guideline standards

The Human Affairs International of California (HAI-CA)* care management center recently completed collating the results of its annual member treatment record review, which included clinical practice guideline audits for select diagnostic categories. The results continue to reflect a positive trend of providers following best practices in maintaining treatment records and adhering to clinical practice guidelines.

For the review, HAI-CA examined a representative sample of records from California network providers (some see a high volume of Magellan members and some a low volume).

Quality of providers' documentation

Using a formal treatment record review tool, our staff evaluated providers’ records for the presence of specific documentation comprising a comprehensive record. View the results below. The aggregate quality goal for 2022 was 80%, which providers far surpassed.

Although overall results are strong, the scores for Coordination of care and Consumer rights and confidentiality indicate opportunities for providers to make a difference in future.

Key opportunities

Greater collaboration with other medical, behavioral health and ancillary providers after the member’s initial evaluation or at other significant points in treatment, along with sharing patient rights information at the beginning of treatment, can contribute to improved treatment outcomes.

Adherence with clinical practice guidelines (CPGs)

This review examined the extent to which providers implement clinical interventions for Magellan members that are consistent with our well-established CPGs, applicable to specific diagnostic groups. 

These results show that network providers continue to exceed the 80% quality benchmark.

Applied behavior analysis results

Magellan also conducts an annual applied behavior analysis treatment record review process. For 2022, out of the 55 providers whose records Magellan audited, all providers met or exceeded documentation requirements across all quality domains. The audit scores averaged 98.65% and were well above the passing threshold of 80%.

Resources to assist you in treatment planning

Magellan quality clinical reviewers offer individualized feedback and consult with providers. Providers who received information regarding the records reviewed can speak with licensed clinicians regarding their results.

For additional information about treatment records and quality reviews, visit our Clinical Forms page. Navigate to our Clinical Guidelines page for the tools we use to assist providers in screening, assessing and treating many common disorders.

Thank you for your ongoing commitment to providing quality behavioral healthcare services.

*In California, Magellan does business as Human Affairs International of California, Inc. and/or Magellan Health Services of California, Inc. – Employer Services.