Provider Materials
Provider materials such as handbooks, forms, provider bulletins and other important information
Provider training
Availity Provider Portal Training — posted March 2021
Provider Education Training — posted February 2021
Provider Claims Education Training
Provider Orientation FAQs
Additional Provider Orientation FAQs
Non-Emergency Medical Transportation Overview
Pharmacy Provider Training
Availity Registration Instructions
Please review the MCC of VA provider handbook to find a complete list of required training for providers.
Provider toolkits
We have developed provider toolkits to serve as a central repository for information on clinical guidance, available tools and resources, trainings and more. We currently have toolkits focused on:
- Pregnant and Parenting Women with Opioid Use Disorder (OUD)
- Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome
Molina Healthcare-Magellan Complete Care (MCC) Acquisition Frequently Asked Questions (FAQs)
Molina Healthcare-Magellan Complete Care Acquisition Frequently Asked Questions
Magellan Complete Care of Virginia (MCC of VA) and Integra Partners Frequently Asked Questions (FAQS)
Personal attendant hazard pay notice from DMAS
Bulletins and announcements
DMAS provider bulletins
Visit the Medicaid Memos and Bulletins to Providers page to read the latest DMAS bulletins.
2021 communications
May 1 changes to prior authorization requirements — posted April 1
Newborn notifications — posted March 19
Annual CAHPS survey — posted March 10
Sub-acute rehab for Medallion 4.0 members — posted March 10
Virginia Medicaid: Spring 2021 Substance Use Disorder Training and Technical Assistance Webinars — posted March 2021
Behavioral health updates — posted February 12
XRT claim denials — posted February 12
REMINDER: New behavioral health service authorization fax number — posted February 3
New provider toolkits available on MCC of VA website — posted February 2
HEDIS 2020 Medical Records Retrieval — posted January 22
Updates to our sepsis policy — posted January 8
2020 communications
New behavioral health service authorization fax number — posted December 28
Untimely pre-certification requests update — posted December 21
Annual Wellness Visits — posted November 19
Untimely pre-certification requests — posted October 30
Upcoming changes to behavioral health service authorization fax number — posted October 30
December 1 changes to prior authorization requirements — posted October 30
Molina Healthcare Acquisition of Magellan Complete Care Provider Notification — posted October 20
November 15 changes to prior authorization requirements — posted October 15
Updates to hospice services — posted October 5
Remind your patients to get a flu shot — posted September 24
Importance of coding accuracy — posted September 11
DMAS-98R Form Submission Request — posted September 8
We speak our members’ language — posted September 3
October 1 changes to prior authorization requirements — posted September 1
Process Timeframes for Crisis Stabilization and Crisis Intervention — posted August 4
Covid-19 Temporary Evaluation & Management Rate Increase — posted August 3
Added Prior Authorization Requirements to Medical J Code Medications — posted July 31
ER Reimbursement Policy Change — posted July 13
Inpatient Diagnosis-Related Group Authorization Updates — posted June 19
Magellan 24-hour crisis line — posted June 18
Remind your patients about sun safety — posted June 16
Funding for Telehealth Available Under FCC’s COVID-19 Program — posted May 19
Importance of Updating Provider Data — posted May 1
Outpatient Therapy Visits — posted April 28
MCC of VA COVID-19 Provider FAQ — posted April 10
Certificate of Medical Necessity for Durable Medical Equipment — posted February 4
2019 Communications
Reasons to Update Provider Data: Your office is (probably) not located in the middle of a lake — posted December 3
Reasons to Update Provider Data: How many ways can people say “hello”? Hint It’s in the thousands — posted November 26
Reasons to Update Provider Data: There’s a check waiting with your name on it — posted November 19
Reasons to Update Provider Data: Members can’t find you — posted November 12
Patient Referrals to Complex Case Management — posted November 4
September Utilization Management Reminders — posted September 30
MCC of VA Usage of Provider Data — posted September 30
Changes to Nursing Facility Reimbursement — posted September 12
Mental Health Skill-building Services (MHSS) Frequently Asked Questions — posted August 1
HIPAA Compliant Communication Exchange for High Quality Care — posted July 23
MCC of VA Contacts List — posted July 16
Service Authorization Reminders — posted June 25
Coordination of Benefits Guidance — posted May 20
Submitting Claims for CenteringPregnancy Services — posted May 16
Authorization Requests Process Update — posted April 19
2018 Communications
Claims Submission Updates — posted September 20
Model Of Care Annual Training Requirements — posted April 23
Provider newsletter
Utilization Management Corner
Availity online authorization portal
Clinical practice guidelines
Standards for utilization management review
Provider Network Corner
Credentialing and recredentialing basics
Keeping practice data current
Pharmacy Corner
Care Coordination Corner
Clinical practice guidelines
Information on clinical practice guidelines is approved by the Department of Medical Assistance Services (DMAS), Magellan Complete Care of Virginia and other health organizations.
The external links are being provided as a convenience and for informational purposes. Such materials should be treated as educational resources to provide clinical practice recommendations, components of proper care, general treatment guidelines, and/or used to increase knowledge, and promote better management of patients. This information should not be considered as inclusive of all proper treatments or methods of care and is not intended to substitute for the independent professional judgment of the treating clinician.
Allergy and Immunology
Allergic Rhinitis and Its Impact on Asthma (ARIA) Guidelines: 2010 Revision
Diagnosis and Management of Food Allergy in the United States
Behavioral Health guidelines
Addiction and Recovery Treatment Services (ARTS)
Assessing and Managing the Patient with Suicidal Ideation
Assessment and Treatment of Generalized Anxiety Disorder in Adults
Assessment and Treatment of Patients with Post-traumatic Stress Disorder and Acute Stress Disorder
Attention Deficit and Hyperactivity Disorder (ADHD)
Diagnosis and Management of ADHD in Adults
Bipolar Disorder
Depression
Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management
Treating Depression in the Primary Care Setting
Eating Disorders
Obsessive-Compulsive Disorder
Treatment of Patients with Obsessive-Compulsive Disorder
Panic Disorder
Magellan’s Adopted Clinical Practice Guideline for the Treatment of Patients with Panic Disorder
Psychiatric Residential Treatment
Schizophrenia
Magellan’s Adopted Clinical Practice Guidelines for the Treatment of Schizophrenia
Substance Use Disorder
Agency Medical Directors’ Group Interagency Guideline on Prescribing Opioids for Pain (2015)
Magellan’s Adopted Clinical Practice Guidelines for the Treatment of Substance Use Disorders
New England Journal of Medicine Treatment of Opioid Use Disorders (2016)
Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Substance Use Disorders Identification Tip Sheet
Additional resources
Cardiovascular guidelines
2013 ACCF/AHA Guideline for the Management of Heart Failure: Executive Summary
2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk
2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure
Evidence-Based Management of Sickle Cell Disease
Statin Use for the Primary Prevention of Cardiovascular Disease in Adults
Diabetes guidelines
American Diabetes Association Standards of Medical Care in Diabetes—2018
Integrative care
Behavioral/Medical care coordination toolkit
Magellan of Virginia Coordination of Care: Behavioral Health and Primary Care Provider Collaboration
Maternal care
American College of Obstetricians and Gynecologists (ACOG) Optimizing Postpartum Care
American Family Physician Update on Prenatal Care
MQIC Routine Prenatal and Postnatal Care
Obstetrics and gynecology guidelines
ACOG Perinatal Depression Screening
Centers for Disease Control and Prevention (CDC) Breast Cancer Screening
Edinburgh Postnatal Depression Scale
Opioid treatment guidelines
CDC Guideline for Prescribing Opioids for Chronic Pain, United States, 2016
Orthopedic guidelines
American College of Physicians (ACP) Treatment of Acute and Chronic Low Back Pain
Pediatric guidelines
American Academy of Child & Adolescent Psychiatry Parameters, Updates and Guidelines
Diagnosis, Evaluation, and Management of High Blood Pressure in Children and Adolescents
Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years
Diagnosis and Management of Acute Otitis Media
Diagnosis, Management, and Prevention of Bronchiolitis
Health Supervision for Children With Down Syndrome (Reaffirmed by AAP in May 2018)
Key Points for Asthma Guideline Implementation
Palivizumab (Synagis) Criteria for Respiratory Syncytial Virus (RSV) Infection
Autism spectrum disorders
Identification and Evaluation of Children with Autism Spectrum Disorders
Pediatric Attention Deficit Hyperactive Disorder (ADHD)
Preventive health guidelines
Bright Futures/AAP Periodicity Schedule
CDC Recommended Adult Immunizations Schedule for ages 19 years or older, 2019
CDC Immunization Schedule by medical conditions and other indications, 2019
CDC Recommended Child and Adolescent Immunization Schedule
Interventions to Prevent Falls in Community-Dwelling Older Adults
Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement
Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement
Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement
The Virginia Department of Health (VDH) Immunization Information System
VDH Virginia Vaccines for Children Program (VVFC)
Perinatal and pediatric preventive care
Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
As a fully integrated health plan, Magellan Complete Care of Virginia (MCC of VA) promotes wellness for its members and encourages providers’ involvement in managing members’ physical and mental health needs. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) is an integral part of our wellness program. These visits include comprehensive health and developmental history (including assessment of past medical history, developmental history and behavioral health status) for eligible children from birth to 20 years old.
As part of our commitment to ensuring members’ wellness, MCC of VA will reach out to the parents of newly enrolled child and adolescent members, as well as members with gaps in care, to assist with setting up an appointment with the child’s primary care physician for an EPSDT visit, if they have not already done so.
MCC of VA is also reaching out to you, the primary care physician, to ask you to please contact your members to get their EPSDT visits scheduled and completed. Please review MCC of VA’s EPSDT program for information on MCC of VA’s EPSDT program and your provider responsibilities.
As part of their benefits, MCC of VA members receive transportation to and from visits through Veyo which can aid in members attending the EPSDT visit. Our Care Coordination team is also a resource for your practice and can be reached by calling 1-800-424-4524 for CCC Plus or 1-800-424-4518 for Medallion 4.0, if members need further assistance in arranging the EPSDT visit.
Additional information on EPSDT can be found in Magellan Complete Care of VA’s provider handbook. You can also find more information at the resources below:
EPSDT Specialized Services Guide for Providers
American Academy of Pediatrics (AAP) Bright Futures Recommendations for Preventative Pediatric Care
Additional resources
Department of Medical Assistance Services (DMAS) EPSDT Manual
AAP Recommendations for Preventive Pediatric Health Care
Agency for Healthcare Research and Quality
VDH Guidelines for Testing Children for Lead Exposure
Virginia Law Protocol for Identification of Children with Elevated Blood Lead Levels
CDC Advisory Committee on Immunization Practices 2020 Immunization Schedules
American Academy of Family Physicians (AAFP)
Pulmonary guidelines
Asthma
American Academy of Pediatrics- Virginia Chapter, Asthma Tool Kit and other resources
National Asthma Education and Prevention Program Asthma Care Quick Reference
Chronic Obstructive Pulmonary Disease (COPD)
Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD)
Safety guidelines
Virginia Department of Social Services Adult Protective Services (APS)
Seatbelt and helmet safety
Tobacco/smoking cessation
Virginia reportable disease list
Member information
When a new CCC Plus member (or Medallion 4.0 member who we determine has healthcare needs that require care coordination) enrolls with MCC of VA, we will conduct an initial Health Risk Assessment to determine the member’s needs and complete an initial individualized care plan (ICP), which includes but is not limited to, the member’s expressed goals, services the member needs and will receive (regardless of payer source), and the member’s preferences for their care and provider selection.
Upon enrollment, each MCC of VA member receives a member ID card reflecting his/her primary care provider (PCP) name and effective date. The MCC of VA Member Services number is located on the back of the ID card.
For information about member benefits or eligibility please refer to our For Members section.
Individualized care plans for members
MCC of VA’s model of care is person-centered, community-focused, and evidence-driven. We focus on activities designed to improve quality of life and health outcomes by targeting and influencing behavioral, social, economic, and clinical determinants of those outcomes at both the individual and group level.
This individualized, person-centered approach engages individuals with disabilities and chronic conditions to effectively interact with the provider delivery system to ensure choice, control, and access to a full array of quality services. This approach ensures optimal outcomes such as independence, health and wellness, and quality of life.
Our Care Coordinators work to develop an ICP with CCC Plus members and any Medallion 4.0 members whose needs require care coordination.
HEDIS Tip Sheets
Adults’ Access to Preventive or Ambulatory Health Services (AAP)
Appropriate Antibiotic Use (URI, CWP, AAB)
Appropriate Testing for Pharyngitis (CWP)
Cervical Cancer Screening in Women (CCS)
Child and 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 Anti-rheumatic 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)
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)
Use of Opioids from Multiple Providers or at High Dosage in Persons without Cancer (PQA1)
Weight Assessment & Counseling for Nutrition & Physical Activity for Children & Adolescents
Well-Child Visits in 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 MCC of VA members.
Other important resources
Provider Quick Reference Guide
For all your Non-Emergent Medical Transportation (NEMT) needs, please contact Veyo at 1-877-790-9472 for CCC Plus members, and 1-833-273-7416 for Medallion 4.0 members.
Register for EFT today via the following link:
Availity Professional and Facility Claim submission is now available. Instructions to register for the Provider portal can be found via the following link:
Electronic Visit Verification implementation
Electronic Visit Verification flyer
HEDIS Telehealth Accepted Codes
HEDIS Telehealth Accepted Codes Reference Guide
Quality Performance Guide 2020 – Your guide to HEDIS®, CAHPS®, and Coding Accuracy
Quality Performance Guide 2020
Addiction and Recovery Treatment Services (ARTS)
MCC of VA vs. Behavioral Health Services Administrator (BHSA) Provider Quick Reference Guide
MCC of VA vs. BHSA Provider Guide
Community Mental Health and Rehabilitative Services (CMHRS) overview for providers
Respite Care Frequently Asked Questions for providers
Nursing Facilities Frequently Asked Questions for providers