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New services requiring preauthorization through Magellan Healthcare

07/09/2018

We will expand our existing partnership with Magellan Healthcare on Aug. 1, 2018, to include preauthorization management of the following elective services:

Cardiac imaging program and implantable devices, and
Outpatient interventional spine pain management for these procedures:
o Spinal epidural injections
o Paravertebral facet joint injections or blocks
o Paravertebral facet joint denervation (radiofrequency (RF) neurolysis)
o Sacroiliac joint injections


Here are the affected codes under the expanded services.

Magellan will work with providers to make sure patients get the care they need, avoid the inconvenience and cost of unnecessary or duplicative services, and reduce their exposure to excess radiation.

Magellan Healthcare applies nationally-accepted criteria for quality and appropriateness of care in its management of authorizations for services. It has managed our outpatient advanced imaging and inpatient and outpatient spine surgery programs for the past few years.

Preauthorization needed for all ConnectiCare members, starting Aug. 1

This expanded program affects all ConnectiCare commercial and Medicare Advantage plans. If you have patients who are in treatment now, please see that they have the necessary preauthorization for these services on or after Aug. 1.

You can submit preauthorization requests to Magellan by calling 1-877-607-2363 or online at radmd.com, starting Aug. 1, 2018. Requests must include patients’ medical records, as well as any other applicable clinical information. Sending the right clinical documentation with original requests will help avoid delays and pended requests.

As part of its review, Magellan will implement a clinical validation of records (CVR) process for CPT codes under the program. This means Magellan will review the patient’s medical records to make sure the clinical criteria are met and support the requested service. If you need an urgent review, please call Magellan Healthcare at the above number. Clinical validation will not be required in these circumstances.