Dean Health Plan works with Magellan Healthcare for review and authorization of our Musculoskeletal (MSK) Care Management Program. This 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 program incorporates the following key components:
- The Musculoskeletal Care Management Program is used 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
- Dean Medicaid
- Magellan’s Musculoskeletal (MSK) Care Management Program manages 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 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 for these procedures may be submitted using Magellan’s website www1.RadMD.com or the Magellan toll-free phone number at 866-307-9729.
- Musculoskeletal surgeries included in this program are non-emergent hip, knee, shoulder, lumbar and cervical spine surgeries. A list of current spine surgery and knee, hip and shoulder surgery CPT codes can be found in the Additional MSK Resources section.
- Facilities will continue to require authorization for length of stay through Dean Health Plan’s Utilization Management Department for inpatient musculoskeletal surgeries for dates of service through 12/31/2019.
- Effective for dates of service beginning 01/01/2020, facilities will not require authorization for length of stay through Dean Health Plan’s Utilization Management Department for inpatient musculoskeletal surgeries.
Magellan customer service
You can contact Magellan's customer service representatives Monday through Friday from 7 am - 7 pm (CST) at 866-307-9729.