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Reminders about services requiring preauthorization through Magellan Healthcare

07/03/2019

Last year, we expanded our existing partnership with Magellan Healthcare to include preauthorization management of cardiac imaging program and implantable devices and outpatient interventional spine pain management. As part of this effort, Magellan implemented a clinical validation of records (CVR) process. This means Magellan will review a patient’s medical records to make sure clinical criteria are met and support the requested service. Please follow the CVR process. Magellan’s audit of clinical records helps us make sure our members receive the most appropriate and effective care.

Submitting clinical record for Outpatient Imaging, Cardiac Procedures and Musculoskeletal Management Program (MSK)
As part of Magellan’s preauthorization review, providers are asked to submit certain aspects of the record for review. There are two ways you can submit clinical records to Magellan:

  • Online: Upload the records through the upload clinical document feature on Magellan’s website, www.RadMD.com. This is the fastest option and expedites the provider’s request because the information is automatically added to the case and sent to Magellan clinicians for review.
  • By fax: Please use a fax cover sheet. Magellan will fax providers back if more clinical information is needed for the preauthorization review.

Reminders about the Magellan preauthorization review:

  • Providers may seek peer-to-peer consultations with Magellan Healthcare’s board-certified physicians by calling Magellan Healthcare at 1-877-607-2363.
  • Providers can find clinical guidelines on www.RadMD.com under “Online Tools/Clinical Guidelines.” The website also offers other online tools and resources for providers, such as checklists and other information.

If you have any questions, please call Magellan Healthcare’s Provider Services Department at 800-327-0641 or Dedicated Magellan Healthcare Provider Relations Manager Charmaine S. Everett at 1-800-450-7281, ext. 32615.