Provider materials and tools

Provider Incentive Programs

Magellan Complete Care is committed to ensuring that our members receive the preventive and recommended care they deserve. As a valued Magellan Complete Care provider, we want to acknowledge your commitment, dedication, and service to our members.

In recognition of how your relationships with our members help them make good decisions about their care -we are implementing a year end, real-time incentive program.

 

The program is:

  • Effective July 22, 2019 through December 31, 2019
  • For claims received by February 29, 2020

 

Fee-for-Service Primary Care Providers (PCPs)

The incentive, an enhanced rate of 200% of the Florida Medicaid fee schedule rate will be paid real-time through the claims payment process based on the codes you bill for Preventative Medicine services provided to Florida Medicaid members. Preventative Medicine CPT codes 99381-99385 and 99391-99395 are included in this incentive for all members under 21 on the date of service.

Capitated Primary Care Providers (PCPs)

The incentive, an enhanced rate of 100% of the Florida Medicaid fee schedule rate in addition to your current reimbursement rate will be paid real-time through the claims payment process based on the codes you bill on claims/encounters for Preventative Medicine services provided to Florida Medicaid members. Preventative Medicine CPT codes 99381-99385 and 99391-99395 are included in this incentive for all members under 21 on the date of service.

 

FQHCs and RQHCs

The incentive, an enhanced rate of 100% of the Florida Medicaid fee schedule rate in addition to your current reimbursement rate will be paid real-time through the claims payment process based on the codes you bill on claims/encounters (see attached) for Preventative Medicine services provided to Florida Medicaid Members. Preventative Medicine CPT codes 99381-99385 and 99391-99395 are included in this incentive for all members under 21 on the date of service.

Claims Received

Payout Issued

July 22,2019 -September 30,2019

November 15, 2019

October 1, 2019 -December 31, 2019

April 15, 2020

 

Suggestions for optimizing the incentive program:

If a member comes in for a sick visit, please make time to complete their well visit. We will pay for both if they are coded appropriately. Please reference correct coding guidelines for modifier 25. Information from the American Academy of Pediatrics on appropriate use of modifier 25 is available at https://www.aap.org/en-us/professional-resources/practice-transformation/getting-paid/Coding-at-the-AAP/Pages/Modifier-25-Primer-Use-It-Dont-Abuse-It.aspx.

 

  • Add Modifier 25 only if completing both the sick and well visits; no need to add if completing only one
  • Adding Modifier 25 is not a guarantee of automatic payment and may require the submission of additional documentation
  • There is no need to report minor health issues identified during this visit

 

Magellan Complete Care pays for one preventive visit each year from October 1st through September 30th. We provide Care Opportunity information for your assigned members, please contact your Provider Support Specialist.

 

We provide transportation for our members through Veyo

 

To be eligible to participate in the physician incentive program, you must be contracted with Magellan Complete Care as a Primary Care Physician (PCP) with assigned members.

 

Payment of claims, including payment of the enhanced rate, remains subject to medical necessity, member eligibility, and all other Medicaid program requirements.

 

If you need additional resources and assistance, please reach out to your local Provider Support Specialist or call us at 1.800.327.8613.