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Magellan updates provider handbook and supplements for 2025

Magellan recently completed its annual review and revision of the Magellan National Provider Handbook and several of the supplements that pertain to EAP providers and to serving specific plans and/or states. These important resources are located on our provider website at www.MagellanProvider.com/handbook.

The handbook and supplements provide the core policy guide for all Magellan-contracted providers, and in it we outline both providers’ and Magellan’s procedural responsibilities in specific areas of behavioral healthcare.

Some areas of the Magellan National Provider Handbook that had notable changes for 2025 include:

• Telehealth (Section 3): Added the need for providers to educate members on the availability of therapy by telehealth services and how to use it.
• New Technologies (Section 3): Substantially streamlined Magellan’s criteria for making determinations about the appropriateness of new behavioral health tools and technologies.
• Health Equity and Cultural Sensitivity (Section 4): This newly titled section reflects Magellan’s increased emphasis on serving member populations who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality.
• Site Visits (Section 4): Differentiated the process of in-person site visits versus virtual desktop quality reviews for telehealth providers.
• Fraud, Waste, Abuse and Overpayment (Section 4): Expanded the list of examples of misrepresented or misleading medical records and bills. Expanded the detail on what’s required during a Special Investigations Unit audit or investigation, including an expansive array of reference documents Magellan may use to ensure accuracy and consistency of the audits. Differentiated progress notes from psychotherapy notes in the medical record. Also outlined appeal procedures for when a provider disagrees with SIU investigative findings.
• A Commitment to Quality (Section 4): Provided an updated range of quality improvement activities with which Magellan encourages providers to engage.
• Quality Outcomes (Section 4): In addition to getting a new title, this section takes a refreshed look at member outcomes measurement and how providers can empower their patients to take an active role in managing their own health and wellness.

Updates to the Organizational/Facility Provider Handbook Supplement included:

• Before Services Begin (Section 3): Deleted the requirement that providers notify Magellan prior to referring a member to another provider, including another Magellan provider.
• Billing Codes and HIPAA Compliance (Section 5): Updated the methods by which facilities can obtain industry-standard billing codes.
• Appendix A - Organization Site Review Preparation Guide: Trimmed the list of documents Magellan needs to review during a facility/organization site visit.
• Appendix B - What You Need to Know About Organization Credentialing and Contracting: Specified that Exhibit A of the provider agreement includes the applicable products, benefit plans and associated reimbursement schedules providers will need to serve Magellan members.
• Appendix E - Benefit Certification: Discharge and Post-Discharge Continuity of Care: Significantly expanded the range of case data Magellan requires to ensure continuity of care and meet NCQA/HEDIS standards for outpatient follow-up after member discharge.

We hope these updated policy documents provide effective procedural guidance for our providers nationwide.