Service |
Initial Request Timeframe |
Continued Stay Request Timeframe |
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| Inpatient | Must be requested within 1 business day of admission. | Must be requested by the start date. |
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| Psychiatric Residential Treatment Facility (PRTF), Therapeutic Group Home (TGH) Early and Periodic Screening, Diagnostic and Treatment (EPSDT) PRTF and EPSDT TGH* | Must be submitted within 1 business day of admission but no earlier than 7 calendar days prior to admission. | Must be submitted by the requested start date but no earlier than 7 calendar days prior to requested start date. |
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| Addiction and Recovery Treatment Services (ARTS) – other than Substance Use Case Management (see below) | Must be requested no later than 1 business day of admission but no earlier than 5 calendar days prior to admission. | Must be requested no later than the requested start date but no earlier than 5 calendar days prior to admission. |
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| Mental Health Services (other than those listed below) | Must be submitted no later than the requested start date but no earlier than 30 calendar days prior to the start date. | Must be submitted no later than the requested start date but no earlier than 30 calendar days prior to the start date. |
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| Therapeutic Foster Care Case Management (TFCCM) | Must be submitted within 10 business days of start date but no earlier than 30 calendar days prior to start date. | Must be submitted no later than the requested start date but no earlier than 30 calendar days prior to the start date. |
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| Substance Use Case Management and Mental Health Case Management Registrations | Must be submitted within 2 business days of the requested start date and no more than 30 days prior to the start date. | Must be submitted within 2 business days of start date but no earlier than 30 calendar days prior to the start date. |
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| Psychosocial Rehabilitation (PSR), Mental Health Peer Support, Substance Use Peer Support Registrations | Must be submitted no later than the requested start date but no earlier than 30 calendar days prior to the start date. | Must be submitted no later than the requested start date but no earlier than 30 calendar days prior to the start date. |
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| Assertive Community Treatment (ACT) | Must be submitted within 1 business day of admission and no more than 30 calendar days prior to start date. | Must be submitted no later than the requested start date but no earlier than 30 calendar days prior to the start date. |
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| Mental Health Partial Hospitalization (MH-PHP) and Mental Health Intensive Outpatient (MH-IOP) | Must be submitted within 1 business day of admission and no more than 7 calendar days prior to start date. | Must be submitted no later than the requested start date but no earlier than 7 calendar days prior to the start date. |
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| Mobile Crisis, 23 Hour Crisis Stabilization, Residential Crisis Stabilization Unit Registrations | Must be submitted within 1 business day of admission. | Not Applicable |
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| Community Stabilization Authorization | Must be submitted within one business day. | Must be submitted by the requested start date and no earlier than 48 hours prior to the requested start date. |
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| Residential Crisis Stabilization Authorization (for services beyond 5 calendar days and 5 units) | Must be submitted by the requested start date and no earlier than 24 hours prior to the requested start date. | Must be submitted by the requested start date and no earlier than 24 hours prior to the requested start date. |
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| Multisystemic Therapy and Functional Family Therapy | Must be submitted within 1 business day of admission. | Must be submitted by the requested start date. |
*For Residential Special Considerations, Initial requests must be submitted within 5 business days of notification by the Residential Care Manager (RCM).
Reconsideration Form
- Please be advised, you may only request a reconsideration for dates of service that have been non-authorized by Magellan. If you wish to obtain authorization for different dates of service, please submit to Magellan’s clinical department your request.
- You have the right to request a Reconsideration of Magellan of Virginia’s (Magellan) initial non-authorization of service. Your Reconsideration request must be received within 30 calendar days from the date of our initial non-authorization letter or the date of the remittance advice containing the denial for requesting reconsideration. Reconsideration requests received after the 30 day time limit will be denied as untimely.
- DIRECTIONS: Use this form to submit a request for reconsideration of Magellan’s non-authorization of services or in response to a claim denial outlined in your Explanation of Benefit. The areas of the form notated with a red asterisk (*) are required. You cannot submit the form if those areas are blank. Attach any additional documentation related to your reconsideration by utilizing the “UPLOAD” or “Browse” button. Additional documentation may include clinical information, VICAP, claim forms, Explanation of Benefit, etc. It is recommended that you submit additional information addressing each criteria or requirement identified as not met in the non-authorization letter. Please give specific details supporting why you believe these criteria or requirements are met.
Click here to access the form.