Important information for the transition

For Services Managed by Gainwell, BPA Health, Telligen and DBH:

• Magellan will honor all authorizations that have been approved and span past July 1, 2024. The end date of the authorization will be the same as what you were provided by the legacy organization.
• A member in active treatment with an out-of-network provider may continue receiving services from that provider for the first 90 days after July 1, 2024, and Magellan will cover the services.
• Tribal members in active treatment with Indian healthcare providers may continue receiving services from that provider for as long as they need to, and Magellan will cover the services.

Submitting authorization requests:

Submit requests to the legacy organization through currently approved processes through June 30, 2024.

Beginning July 1, 2024, submit requests to Magellan at MagellanofIdaho.com.

Preauthorization requirements can be found in the Provider Handbook Supplement and Appendices.

Filing claims:

Claims for outpatient services and recovery support:

Claims for services rendered through 11:59 p.m. MT on June 30, 2024: Submit to the legacy organization.

Claims for services rendered beginning 12:00 a.m. MT on July 1, 2024: Submit to Magellan at MagellanofIdaho.com.

Claims for inpatient and residential services:

For stays with discharges up through 11:59 p.m. MT on June 30, 2024: Submit claims the legacy organization.

For stays with admission up through 11:59 p.m. MT on June 30, 2024, and discharge starting at 12:00 a.m. MT on July 1,2024:

For DRG reimbursement, submit claims for the full stay to the legacy organization.

For per diem reimbursement:

For services up through 11:59 p.m. MT on June 30, 2024: Submit claims to the legacy organization.

For services from 12:00 a.m. MT on July 1, 2024, and beyond: Submit claims to Magellan at MagellanofIdaho.com.

For Services Managed by Optum:

• Magellan will waive all outpatient authorizations for the first 90 days after July 1, 2024. You can continue providing care, and claims will be paid.
• Some services have thresholds to be reached before an authorization is required. Magellan is resetting thresholds to zero (0) on July 1, 2024.
• A member in active treatment with an out-of-network provider may continue receiving services from that provider for the first 90 days after July 1, 2024, and Magellan will cover the services.
• Tribal citizens in active treatment with Indian healthcare providers may continue receiving services from that provider for as long as they need to, and Magellan will cover the services.

Submitting authorization requests:

• For dates of service through June 30, 2024: Submit authorization requests to Optum through the standard process.
  • If you submit an authorization request with dates of service that begin before July 1, 2024, and end after that date:
    • Optum will only process dates of service through June 30, 2024.
    • Optum will not process dates of service beginning July 1, 2024. That part of the request will be transferred to Magellan for processing.
  • If Optum approves the request for dates of service through June 30, 2024, you do not have to send anything to Magellan for the dates of service beginning July 1, 2024. Care for your patients will continue uninterrupted.
  • If Optum denies the request for dates of service before July 1, 2024, please follow our Appeals process.
• For dates of service beginning July 1, 2024:
  • Magellan’s online authorization request function will be live at 12:00 a.m. on July 1, 2024, at MagellanofIdaho.com. Submit authorization requests there.

Filing claims:

• For services rendered through 11:59 p.m. MT on June 30, 2024: Submit claims to Optum through the standard process.
• For services rendered July 1, 2024, and after: Submit claims to Magellan at MagellanofIdaho.com.