Musculoskeletal (MSK) Program - Providers, Dean Health Plan

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Musculoskeletal (MSK) Program-Effective August 1, 2017

Dean Health Plan has entered into an agreement with Magellan Healthcare to participate in their Musculoskeletal Care Management Program. This program includes prior authorization by the treating physician for non-emergent inpatient and outpatient musculoskeletal surgeries, specifically hip, knee, shoulder, and lumbar and cervical spine.

This new program incorporates the following key components:

  • Effective date is August 1, 2017 for the following Dean Health Plan product lines: Commercial – Dean HMO, Dean POS, Dean PPO, Dean Focus EPO; Dean Administrative Services Only (ASO); Dean Advantage and Dean Medicaid.
  • Magellan’s Musculoskeletal Care Management Program (MSK) will manage the medical necessity review for non-emergent inpatient and outpatient musculoskeletal surgeries through physician authorization, prior to performing the surgery.
    • Members who require the services of a provider who is not a Dean Health Plan Network provider may require two (2) authorizations. The initial authorization will need to be obtained for the use of the non-network provider via Dean Health Plan Utilization Management Department.
    • Authorization may be submitted using Magellan’s website www.RadMD.com or the Magellan toll-free phone number at (866) 307-9729 for procedures scheduled on or after August 1, 2017.
    • Musculoskeletal surgeries included in this program are non-emergent hip, knee, shoulder, and lumbar and cervical spine surgeries. A list of MSK affected CPT codes is available here.
    • Facilities will continue to require authorization for length of stay through Dean Health Plan’s Utilization Management Department, for inpatient musculoskeletal surgeries.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. You must continue to pay your Medicare Part B premium. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year.

Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

Dean Advantage is an HMO/HMO-POS plan with a Medicare contract. Enrollment in Dean Advantage depends on contract renewal.

 H9096_WEB17v12 Approved

Additional Resources

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Magellan home page

Magellan Clinical Guidelines for musculoskeletal (MSK) surgeries

MSK frequently asked questions

MSK Quick Reference Guide

MSK Checklist

MSK Process Presentation

Recorded MSK provider training webinar

MSK CPT Codes

Magellan Customer Service

You can contact Magellan's customer service representatives Monday through Friday from 7 a.m. to 7 p.m. (CST) at (866) 307-9729.

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