General Provider Communication

Subject:  Contract Modification Requests and Member Notifications

Action:    Please review requirements outlined below carefully.

 

Dear Provider,

 

Magellan Health Services of Arizona would like to remind its network partners of the requirements regarding contract modifications. 

 

REQUESTS FOR CONTRACT MODIFICATION:

As stated in Exhibit B2 of your contract, providers must make contract modification requests to Magellan at least 60 days before the requested effective date of the change. Magellan's obligation is to provide an approval or denial decision regarding the request within 30 days of receipt of the complete contract modification request from the provider. These contract modification scenarios include changes to service code rates, additions of new programs, termination of programs, site changes (adds/closures/relocations), and reductions in capacity. Making these requests at least 60 days in advance allows Magellan to evaluate the potential impact to our network sufficiency and to determine if adjustments are needed. This timeframe also supports the ability to complete credentialing or contracting processes which need to be completed for approved requests before the effective date of the change.  If the advance request timeline is not adhered to, the provider assumes responsibility for services rendered prior to the approved effective date. 

 

As stated in your Provider Participation Agreement (PPA), Section 11, a provider wishing to terminate their contract in its entirety (without cause) requires a 90 day notification to Magellan.

 

The process to request a hold on referrals is also referenced in your Exhibit B2 and currently requires at least 60 days advance request prior to the effective date. Magellan is reviewing this for possible modification given that providers requesting to go on hold may require a more expedited turnaround.

 

All contract modification requests should be sent to your assigned Magellan contract coordinator.

 

MEMBER NOTICES FOR PROGRAM CHANGES OR TERMINATIONS

Magellan recently discussed and reviewed the obligations outlined in our Scope of Work with the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS) regarding member notices.  You will find language in your PPA Section 2.25, "Notices to Enrollees," Part B and C, regarding the timeframes by which members must receive notifications of program changes or contract terminations. 

 

Through discussion with ADHS/DBHS, we have clarified that it is the RBHAs obligation to send member letters regarding provider program changes or contract terminations. Therefore, Magellan member letters must be approved by ADHS/DBHS prior to distribution to members and must include the Magellan Member Service phone number (800-564-5467, TTY 800-424-9831) as the point of contact for members to discuss transfers to other providers, if applicable.

 

As such, we will be partnering with you to ensure we have the correct member mailing address information in order to communicate changes to members. Providers may send their own member notifications regarding program changes (in addition to what Magellan will send), however all member notices sent by providers must be reviewed and approved by Magellan BEFORE the letters are sent to members.  Provider notices to members regarding program changes must also include the Magellan Member Service number as a contact for questions and referrals.  As you work with your Magellan contract coordinator and/or provider relations liaison regarding program changes, please ensure Magellan has a copy of any proposed member letter your organization wishes to send so we may review and approve.  We will also coordinate with you if member transition grids are necessary.

 

Thank you for your continued cooperation in this matter. If you have questions, please contact your contract coordinator or provider relations liaison.

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