Provider Notice

Provider Manual Sections 3.6, 3.14 3.16 Revised

Date: Feb. 11, 2014 Notice Number: 314
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ADHS/DBHS has revised Provider Manual Sections 3.6, Member Handbooks; PM 3.14, Securing Services and Prior Authorization; and PM 3.16, Behavioral Health Drug List. The documents linked below were effective Feb. 5, 2014, and have been posted to the Magellan Provider Manual. Please take some time to review these documents.

PM Section 3.6 (clean)

Revision Notice Matrix - PM 3.6

PM Section 3.14 (track)

PM Section 3.14 (clean)

Revision Notice Matrix - PM 3.14

PM Attachment 3.14.1, Admission Psychiatric Acute Hospital and Sub-Acute Auth Criteria

PM Attachment 3.14.2, Continued Stay Psychiatric Acute Hospital and Sub-Acute Auth Criteria

PM Attachment 3.14.3, Behavioral Health Inpatient Facility Admission Auth Criteria

PM Attachment 3.14.4, Behavioral Health Inpatient Facility Continued Stay Auth Criteria

PM Attachment 3.14.5, C/A Behavioral Health Residential Facility Adm/Cont Stay Auth Criteria

PM Attachment 3.14.6, C/A Behavioral Health Residential Facility Adm/Cont Stay Auth Criteria

PM Attachment 3.14.7, C/A HCTC Continued Stay Auth Criteria

PM Attachment 3.14.8, Adult Behavioral Health Residential Facility Adm/Cont Stay Auth Criteria

PM Attachment 3.14.9, Adult Behavioral Health Residential Facility Adm/Cont Stay Auth Criteria

PM Attachment 3.14.10, Adult HCTC Admission and Continued Stay Auth Criteria

PM Form 3.14.1, CON - Inpatient Facilities for T/RBHAs and Their Contracted Providers

PM Form 3.14.2, RON - Inpatient Facilities for T/RBHAs and Their Contracted Providers

PM Form 3.14.3, T/RBHA Prior Auth Request

PM Form 3.14.4, Adult Behavioral Health Residential Facility or HCTC Continued Stay Review

PM Form 3.14.5, Adult Behavioral Health Residential Facility or HCTC Preadmission Review

PM Form 3.14.6, Request for C/A HCTC Intervention

PM Forma 3.14.6, Solicitud de Intervencion de HCTC Para Ninos/Adolescentes

PM Form 3.14.7, Request for C/A BH Inpatient Facility or BH Residential Facility Intervention

PM Forma 3.14.7, Solicitud de Intervencion Para Ninos/Adolescentes

PM Form 3.14.8, Guardian Request for Behavioral Health Inpatient Facility (C/A Only)

PM Form 3.14.9, BH Inpatient Facility or BH Residential Facility Additional Info Request (C/A Only)

PM Form 3.14.10, C/A 45-Day Clinical Review for Continued Prior Auth of BH Inpatient Facility or BH Residential Facility

PM Form 3.14.11, C/A 60-Day Clinical Review for Continued Prior Auth of HCTC

The Magellan specific CON-RON forms have also been updated to reflect new terminology and formatting and have been posted to the Magellan Provider Manual website.

PM Section 3.16 (track)

PM Section 3.16 (clean)

Revision Notice Matrix - PM 3.16

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If you have any questions about this provider notice, please contact your provider relations liaison.

In accordance with ADHS/DBHS guidelines, providers are required to comply with the updated policies and procedures presented in provider notices. Where applicable, this information is incorporated into the ADHS/DBHS Provider Manual, Magellan Health Services of Arizona Edition. The full provider manual and provider notices are available at the For Providers area of Magellan's Web site, www.MagellanofAZ.com.