In an effort to improve the quality of services provided to Virginia Premier CompleteCare members, Virginia Premier entered into an agreement with Magellan Healthcare, Inc. to implement a behavioral health management program. As of October 6, 2014, Virginia Premier CompleteCare will transition management of the following behavioral health and substance abuse treatment services to Magellan:
  • Crisis Calls 24/7 (Customer Service and Clinical Calls)
  • Inpatient Precertification / Concurrent Review
  • Ambulatory Follow-up / Discharge Planning
  • Partial Hospitalization Precertification/Concurrent Review
  • Assessment and BH intervention services for SMI population
  • An “Outpatient Solutions” Program
  • Quality Improvement / Reporting
  • Targeted Case Management (Substance Abuse only)
  • Prior Authorization and medical necessity reviews
Please note that Virginia Premier will continue to manage the Provider Network and process all the claims.

What You Need to Know

While all authorizations will be transferred and honored by Magellan, pending authorizations submitted prior to October 6, 2014 will be reviewed and processed by Virginia Premier. All authorizations submitted on and after October 6, 2014 will be reviewed and processed by Magellan. The time frames for authorization requests will remain the same as they were prior to the management transition. Magellan will notify providers of all pending, approved, or denied authorizations by mail.

Submitting Preauthorization Requests

All prior authorization requests for behavioral health and substance abuse treatment services should be directed to Magellan beginning October 6, 2014.  Please contact Magellan at 1-800-424-4971 for telephonic authorization of all behavioral health and substance abuse treatment services, except the following outpatient services: Mental Health Skill Building, Psychosocial Rehabilitation and Intensive Community Treatment.  The authorization request forms for these services are located below, and in the Provider Forms Library on our website, and should be faxed to Magellan at 1-866-354-8758. The following Behavioral Health and Substance Abuse Services will need Magellan authorization: The following Behavioral Health and Substance Abuse Services will not require authorizations by Magellan:
  • All Outpatient Mental Health and Substance Abuse Services (not including intensive)
  • All Medication Management
  • Opioid Treatment (H0020)
  • Substance Abuse Crisis Intervention (H0050 – notification only)
  • TDO/ECO emergency services (notification only)
  • Crisis Stabilization (H2019 – notification only)
  • Crisis Intervention (H0036 – notification only)

Questions

Questions about prior authorization for behavioral health services may be directed to Magellan at 1-800-424-4971. Assistance is available from 8 a.m. to 5 p.m., Monday through Friday.