Provider materials such as handbooks, forms, provider bulletins and other important information
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.
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)
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.
New Durable Medical Equipment Policies — posted June 17
July 1 changes to prior authorization requirements — posted June 1
Retroactive reviews updates — posted May 28
Authorization requirements and fax line updates — posted May 28
Crisis Stabilization Update — posted May 20
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
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
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
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
Claims Submission Updates — posted September 20
Model Of Care Annual Training Requirements — posted April 23
Utilization Management Corner
Provider Network 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
Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence
Behavioral Health guidelines
Assessment and Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder, and Quick Reference Guide (2004); and the APA Guideline Watch: Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder (2009)
Psychiatric Residential Treatment
Substance Use Disorder
American Psychiatric Association (APA) Treating Substance Use Disorders: A Quick Reference Guide (2006), and Guideline Watch (April 2007): Practice Guideline for the Treatment of Patients With Substance Use Disorders, 2nd Edition
Behavioral/Medical care coordination toolkit
Obstetrics and gynecology guidelines
Opioid treatment guidelines
Autism spectrum disorders
Pediatric Attention Deficit Hyperactive Disorder (ADHD)
Preventive health guidelines
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:
Chronic Obstructive Pulmonary Disease (COPD)
Seatbelt and helmet safety
Virginia reportable disease list
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
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
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
HEDIS Telehealth Accepted Codes
Quality Performance Guide 2020 – Your guide to HEDIS®, CAHPS®, and Coding Accuracy
Addiction and Recovery Treatment Services (ARTS)
MCC of VA vs. Behavioral Health Services Administrator (BHSA) Provider Quick Reference 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