Provider materials and tools

Provider assessment initiative

Better accessing and understanding our members' needs.

We need your commitment in conducting both a health risk assessment and a substance abuse screening. It is imperative that we recognize all conditions and substance abuse issues quickly so that they can be treated both from a physical and mental health perspective.

To participate in the provider assessment initiative the provider commits to the following:

  • Administer the Magellan Complete Care provider health risk assessment
  • Perform a substance abuse screening using one of the SAMHSA recognized tools: AUDIT, CAGE AID or DAST-10 
  • Accurately and timely submit claims for services rendered including all diagnosis codes applicable to the member 
  • With claims provide copies of all completed tools, assessments and screenings

 For obstetric providers: 

  • Offer and complete the Healthy Start Prenatal Risk Screen form at the first prenatal visit
  • Within 5 days of the visit, submit the Healthy Start Prenatal Risk Screen form to the county health department where the screening occurred 
  • Submit a copy of the Healthy Start Prenatal Risk Screen form to Magellan Complete Care with the claim submission

Payment, billing and claims

Primary care physicians, federally qualified health centers and community mental health center providers:
  • As you use the Health Risk Assessment (HRA) and one of the approved substance abuse screening tools (AUDIT, CAGE-AID or DAST-10), complete the full visit requirements and bill the appropriate Evaluation and Management (E&M) visit code for new or established patients (99201 – 99215)
  • On the same claim form bill for the HRA and completion of a substance abuse screening by using 99420; which will be paid at $50
  • These services should not be billed separately
  • The results of the HRA and substance abuse screening must be attached to the claim for payment 
  • The service must be rendered within 90 days from the date the providers are notified of the program
  • The service must be rendered within 90 days from the date the providers are notified of the program
  • Magellan Complete Care will pay one time a year, per member, per provider or provider group
  • If you submit electronic claims, you should submit the assessments through the electronic clearing house
For obstetric providers: 
  •  Please submit the complete the healthy start prenatal risk screen form as well.

If your practice or organization submits electronic claims please submit your assessment all through the electronic clearing house. It is critical for all diagnosis to be listed on your claims submissions in order for us to identify, via claims data, our members’ health conditions in a standardized manner. Complete data will allow Magellan Complete Care to partner in providing whole-person management.


Better understand the current health status of your patients

If you would like assistance locating additional services or care, please do not hesitate to contact Magellan Complete Care. Our health services team, that includes behavioral health clinicians, nurses and physicians, is available to assist you in care planning as well as consultation.

Substance abuse referrals and follow-up

Patients experiencing difficulty with substance or alcohol abuse may require additional services and assessment from a certified substance abuse specialist or from a structured community program.

If you are not within your practice scope to treat one of our members with these complex substance abuse conditions, we highly recommend that you contact us so we can help you with finding additional resources and referrals.


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