Policies and Procedures 
- Provider Handbook
- Behavioral Health Care Guidelines
- Behavioral Medical Necessity Criteria Guidelines
- Prior Authorization Criteria
- Prior Authorization Guide
- Continuity of care provisions
Provider Bulletins and Announcements
- Important updates on acquisition by Molina Healthcare
- Discontinuation of Florida Medicaid COVID-19 flexibilities
- Prior authorization update
- Diagnosis code update (MEDX)
- Diagnosis code update (LADX)
- Prior authorization requirement changes
- COVID-19 vaccine update
- Durable Medical Equipment and Medical Supplies (DME)
- DME Covered Services
- Virtual Lunch and Learn: Breaking the barrier of substance use stigma
- E&M Provider upcoding notice
- Interim billing
- HEDIS Kickoff
- Pediatric immunization resources
- Sepsis guidelines update
- Prior authorization update
- Provider authorizations, appeals and disputes
- Electronic Visit Verification (EVV) update
- Pharmacy network changes- Walgreens and Winn-Dixie
- MCC of FL acquisition by Molina Healthcare notice with FAQs
- Claim complaint submission guidelines
- Changes to prior authorization requirements
- Well Child Incentive Program- Fee for service primary care providers (PCPs)
- MCC of FL’s review for inpatient services
- Laboratory services update
- Important funding announcement for all Medicaid providers
- Prior authorization reinstatement
- COVID-19 Telehealth FCC funding notice
- MCC of FL’s online behavioral health tool, On To Better Health
- Update to coverage of services and other provisions during the state of emergency
- Medicaid Telemedicine Guidance for Medical and Behavioral Health Providers
- Update on Medicaid coverage of services during the state of emergency
- H.O.M.E. program billing tip sheet
- The New Coronavirus (COVID-19) Outbreak Update
- Telehealth services reminder
- Peer-to-peer and Baker Act reminder
Provider Toolkit
We have developed a provider toolkit to serve as a central repository for information on clinical guidance, available tools and resources, trainings and more. We currently have a toolkit focused on:
- Parenting and Pregnant Women with Opioid Use Disorder (OUD)
Explore Toolkit
Prescription Drugs 
- AHCA Preferred Drug List
- The PDL includes all of the drugs that are covered by our plan. It also informs you about any rules or restrictions on drugs, such as limits on the amount that a member can get for certain drugs.
- If your patient needs a medication that is not on the list of drugs we will pay for, please call us at 800-327-8613 to discuss an exception.
- Cover My Meds User Guide
- Magellan Rx Pharmacy and OTC
- Preferred Drug List
- Drug recalls
Provider Training
Provider Orientation
Disease & Disorder Management
Acute stress disorder & Post-traumatic stress disorder
Asthma – diagnosis and management
Attention Deficit Hyperactivity Disorder
Autism spectrum disorders
Bipolar disorder
Chronic obstructive pulmonary disease (COPD) – Global strategy for the diagnosis, management and prevention
Depression
Diabetes – standards of medical care
Eating disorder
Generalized anxiety disorder
Heart disease – management of heart failure and diagnosis and management of patients with stable ischemic heart disease
High blood pressure – prevention, detection, evaluation, and treatment
HIV/AIDS
Immunizations Schedules
- 0-18 years: Center for Disease Control and Prevention
- Adult: Center for Disease Control and Prevention
- Managing suicidal patients
- Magellan Clinical Practice Guideline for Assessing and Managing the Suicidal Patient
- Assessing and Managing the Suicidal Patient: Keeping the Patient Safe: Tip Sheet
Medical Foster Care (MFC) Provider Education
Medical Records
Medication
Medication Assisted Treatment (MAT)
- Medication assisted treatment paves road to recovery
- OOWS – Objective Opioid Withdrawal Scale & SOWS – Subjective opiate withdrawal scale
- Substance abuse tip sheet and pharmacotherapy for substance use disorders
Obesity
Panic disorder
Prenatal practice guidelines
Preventive services
Schizophrenia
Substance use disorder
- American Psychiatric Association Practice Guidelines
- Magellan Substance Use Disorders Identification Tip Sheet
- Ambulatory Intoxication and Withdrawal Management
- APA Practice Guidelines
- AUDIT – Alcohol Use Disorders Identification Test
- Audit Tools – You can find clinical practice guideline audit tools in National Provider Handbook Appendix A
- CAGE
- CAGE-AID
- DAST – Drug Addition Screening Test
- Understanding and Meeting the Needs of Children and Adolescents at High Risk
Tobacco cessation
- CDC Tobacco Cessation Resources
- Treating tobacco use and dependence
- Helping our members quit tobacco
Tip Sheets
- About Ebola (Spanish)
- About Heart Failure (Spanish)
- About High Blood Pressure (Spanish)
- Bipolar Disorder (Spanish)
- Depression (Spanish)
- Get Tested for HIV (Spanish)
- Living with Asthma (Spanish)
- Living with Type 2 Diabetes (Spanish)
- Obsessive Compulsive Disorder (Spanish)
- Schizophrenia (Spanish)
- Suicide Prevention (Spanish)
- Obstetrics and coding claims
Application Guides and Demos
- Administrator Set Up Guide
- Administrator Set Up Demo
- Change Password Guide
- Check Claims Status Guide
- Check Claims Status Demo
- Check Member Eligibility Guide
- Check Member Eligibility Demo
- Edit My Profile Guide
- EFT Guide
- ICP/View Care Plan Demo
- Medicaid Disclosure Form Guide
- My Practice Guide
- Plan-Specific Reports Demo
- Request Authorizations Demo
- Request or View Authorizations Guide
- Submit a Claim Online Guide
- View Authorizations Demo
- Recovery and Resiliency
Cultural Competence
- Cultural Competence Resource Kit
- Culture Competence Information Sheets
- Cultural Competence Introduction Presentation
- Hospital discharge planning resource guide
Member Information
The Adobe Reader is required to view PDF files.
HEDIS Tip sheets
- Adults’ access to preventive or ambulatory health services (AAP)
- Appropriate antibiotic use (URI, CWP, AAB)
- Appropriate testing for pharyngitis (CWP)
- Asthma medication ratio (AMR)
- Breast cancer screening (BCS)
- Cervical cancer screening in women (CCS)
- Child adolescent well-care visits (WCV)
- Childhood immunization status (CIS)
- Chlamydia screening in women (CHL)
- Colorectal cancer screening (COL)
- Comprehensive diabetes care (CDC)
- Controlling high blood pressure (CBP)
- Disease modifying antirheumatic drug therapy for rheumatoid arthritis (ART)
- Immunizations for adolescents (IMA)
- Lead screening in children (LSC)
- Medication adherence for chronic medications (statins, ACE/ARBs, oral antidiabetics)
- PQA1: Use of opioids from multiple providers or at a high dose in people without cancer
- Prenatal and postpartum care (PPC)
- Statin therapy for patients with cardiovascular disease (SPC)
- Statin therapy for patients with diabetes (SPD)
- Use of imaging studies for low back pain (LBP)
- Weight assessment & counseling for nutrition and physical activity for children and adolescents
- Well-child visits within the first 30 months of life (W30)
Telehealth tip sheet
Telehealth has been around for many years. It has shown to be a cost-effective, evidence-based alternative option for delivering healthcare for behavioral health diagnoses and treatments. It’s becoming widely reimbursed by payers such as health plans, states, CMS and most recently, NCQA for HEDIS.
Please use this tip sheet as a reference tool to see what measures can be provided via telehealth and how to appropriately code telehealth services provided to Magellan Complete Care of Florida members.