Provider Materials

Provider materials such as handbooks, forms, provider bulletins and other important information

March 2020
MCC of VA Provider Handbook

Provider training

{LINKS}

Please review the MCC of VA provider handbook {LINK} to find a complete list of required training for providers.

Bulletins and announcements

Here you can find copies of provider communications that have been sent to providers.

Provider bulletins

{LINKS}

 

Provider newsletter

Spring 2020

CONTENT HERE

Winter 2020

Clinical practice guidelines

Clinical practice guidelines

Information on clinical practice guidelines 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. This information 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 https://www.ncbi.nlm.nih.gov/pubmed/20816182

Diagnosis and Management of Food Allergy in the United States
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241964/

 

Primary Care Guidelines for the Management of Persons Infected With HIV: 2013 Update by the HIV Medicine Association of the Infectious Diseases Society of America
https://academic.oup.com/cid/article/58/1/e1/374007

 

Behavioral Health Guidelines

 

Addiction and Recovery Treatment Services (ARTS)

http://www.dmas.virginia.gov/#/arts

 

Assessing and Managing the Patient with Suicidal Ideation
https://www.magellanprovider.com/media/11749/suicide.pdf

 

Assessing and Managing the Patient with Suicidal Ideation: Keeping the Patient with Suicidal Ideation Safe

https://www.magellanprovider.com/media/11750/prov_suic_tipsheet.pdf

 

Assessment and Treatment of Generalized Anxiety Disorder in Adults

https://www.magellanprovider.com/media/11748/gad.pdf

 

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).

https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd.pdf

 

Assessment and Treatment of Patients with Post-traumatic Stress Disorder and Acute Stress Disorder

https://www.magellanprovider.com/media/11743/ptsd_asd.pdf

 

Attention Deficit and Hyperactivity Disorder (ADHD)

https://www.magellanprovider.com/media/11789/adhd.pdf

 

Diagnosis and Management of ADHD in Adults
https://www.aafp.org/afp/2014/1001/p456.html

 

Bipolar Disorder

The American Psychiatric Association (APA) Guideline Watch (November 2005): Practice Guideline for the Treatment of Patients with Bipolar Disorder, Second Edition
https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar-watch.pdf

The American Psychiatric Association’s (APA) Practice Guideline for the Treatment of Patients with Bipolar Disorder, Second Edition
https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar.pdf

Magellan’s Update of its Introduction to the American Psychiatric Association’s Clinical Practice Guideline for the Treatment of Patients with Bipolar Disorder
http://www.magellanprovider.com/media/11746/bipolar.pdf

 

Depression

The American Psychiatric Association’s (APA) Practice Guideline for the Treatment of Patients With Major Depression, Third Edition
https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management
http://pediatrics.aappublications.org/content/pediatrics/120/5/e1313.full.pdf

Magellan’s Adopted Clinical Practice Guideline For the Assessment and Treatment of Patients With Major Depressive Disorder
http://www.magellanprovider.com/media/11745/depression.pdf

Treating Depression in the Primary Care Setting
http://www.magellanprovider.com/media/11790/f-pce10-pcp-dep.pdf

Eating Disorders

 

American Dietetic Association’s Position of the American Dietetic Association: Weight Management (2009)

https://jandonline.org/article/S0002-8223(08)02204-9/pdf

 

American Psychiatric Association’s (APA) Practice Guideline for the Treatment of Patients with Eating Disorders, Third Edition (2006) and Guideline Watch (August 2012)

https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/eatingdisorders.pdf

 

Magellan’s Adopted Clinical Practice Guideline for the Assessment and Treatment of Patients With Eating Disorders

https://www.magellanprovider.com/media/11747/eating_disorders.pdf

 

Position of the Academy of Nutrition and Dietetics: Interventions for the Treatment of Overweight and Obesity in Adults (2016)

https://jandonline.org/article/S2212-2672(15)01636-6/pdf

 

Obsessive-Compulsive Disorder

 

American Psychiatric Association’s (APA) Practice Guideline for the Treatment of Patients With Obsessive-Compulsive Disorder, First Edition (2007) and APA Guideline Watch (2013)

https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd-watch.pdf

 

Treatment of Patients with Obsessive-Compulsive Disorder
https://www.magellanprovider.com/media/11752/ocd.pdf

 

Panic Disorder

 

American Psychiatric Association’s (APA) Practice Guideline for the Treatment of Patients With Panic Disorder, Second Edition (January 2009) and the companion Quick Reference Guide

https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/panicdisorder.pdf

 

Magellan’s Adopted Clinical Practice Guideline for the Treatment of Patients with Panic Disorder https://www.magellanprovider.com/media/11753/panic.pdf

 

Psychiatric Residential Treatment

 

American Academy of Child & Adolescent Psychiatry (AACAP) Principles of Care for Children in Residential Treatment Centers https://www.aacap.org/App_Themes/AACAP/docs/clinical_practice_center/principles_of_care_for_children_in_residential_treatment_centers.pdf

 

Building Bridges Initiative
http://www.buildingbridges4youth.org/events/2010/12/building-bridges-initiative-magella

 

Schizophrenia

American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients With Schizophrenia, Second Edition (2004), and Guideline Watch (2009)
https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/schizophrenia.pdf

American Psychiatric Association (APA) Guideline Watch for the Treatment of Patients with Schizophrenia (2009)
https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/schizophrenia-watch.pdf

Magellan’s Adopted Clinical Practice Guidelines for the Treatment of Schizophrenia
http://www.magellanprovider.com/media/11754/schizophrenia.pdf

Substance Use Disorder

 

Agency Medical Directors’ Group Interagency Guideline on Prescribing Opioids for Pain (2015)

http://www.agencymeddirectors.wa.gov/Files/2015AMDGOpioidGuideline.pdf

 

American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients with Alcohol Use Disorder” (2018) American Psychiatric Association (2018)

https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9781615371969

American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Substance Use Disorders, Second Edition (May 2006)
https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/substanceuse.pdf

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
https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/substanceuse-watch.pdf

CAGE and CAGE-AID

https://www.integration.samhsa.gov/images/res/CAGEAID.pdf

Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Substance Use Disorders (2015)
https://www.healthquality.va.gov/guidelines/MH/sud/VADoDSUDCPGRevised22216.pdf

 

Magellan’s Adopted Clinical Practice Guidelines for the Treatment of Substance Use Disorders
http://www.magellanprovider.com/media/11755/substance_abuse.pdf

 

National Institute on Drug Abuse Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide (2014)
https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/podata_1_17_14.pdf

 

New England Journal of Medicine Treatment of Opioid Use Disorders (2016)

https://www.nejm.org/doi/pdf/10.1056/NEJMra1604339

Screening, Brief Intervention, and Referral to Treatment (SBIRT)
https://www.integration.samhsa.gov/clinical-practice/sbirt

Substance Use Disorders Identification Tip Sheet
http://www.magellanprovider.com/media/11756/sa_tipsheet.pdf

Substance Use Screening Tools

https://www.integration.samhsa.gov/clinical-practice/screening-tools

 

 

Additional resources

 

Magellan Provider Guidelines

https://www.magellanprovider.com/providing-care/clinical-guidelines/clinical-practice-guidelines.aspx

 

Cardiovascular Guidelines

2013 ACCF/AHA Guideline for the Management of Heart Failure: Executive Summary
http://circ.ahajournals.org/content/128/16/1810

 

2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk

https://www.ahajournals.org/doi/full/10.1161/01.cir.0000437740.48606.d1

 

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a

 

2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart Disease

https://www.jtcvs.org/article/S0022-5223(14)01776-0/fulltext

 

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults
https://jamanetwork.com/journals/jama/fullarticle/1791497

 

2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure

http://www.onlinejacc.org/content/accj/70/6/776.full.pdf

 

AHA/AACF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and Other Atherosclerotic Vascular Disease: 2011 Update
https://www.ahajournals.org/doi/10.1161/cir.0b013e318235eb4d

Clinician Guide to the ABCs of Primary and Secondary Prevention of Atherosclerotic Cardiovascular Disease

https://www.acc.org/latest-in-cardiology/articles/2018/03/30/18/34/clinician-guide-to-the-abcs

Evidence-Based Management of Sickle Cell Disease

https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease

Statin Use for the Primary Prevention of Cardiovascular Disease in Adults

https://jamanetwork.com/journals/jama/fullarticle/2584058

 

Diabetes Guidelines

American Diabetes Association Standards of Medical Care in Diabetes—2018 https://care.diabetesjournals.org/content/diacare/suppl/2017/12/08/41.Supplement_1.DC1/DC_41_S1_Combined.pdf

Integrative Care

Behavioral/Medical Care Coordination Toolkit

Magellan of Virginia Coordination of Care: Behavioral Health and Primary Care Provider Collaboration
https://www.magellanofvirginia.com/media/2255/10-2016_bh-pcp_coc_provider_training.pdf

 

Magellan of Virginia Coordination of Care: Behavioral Health and Primary Care Provider Collaboration recorded training

 

Magellan of Virginia Coordination of Care Between Behavioral Health and Primary Care Providers Frequently Asked Questions (FAQ)
https://www.magellanofvirginia.com/media/2323/faq-_coordination_of_care_between_bh_and_pcps.pdf

 

Maternal Care

 

American College of Obstetricians and Gynecologists (ACOG) Optimizing Postpartum Care
https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care

 

American Family Physician Update on Prenatal Care
https://www.aafp.org/afp/2014/0201/p199.html

 

MQIC Routine Prenatal and Postnatal Care

http://www.mqic.org/pdf/2018_mqic_routine_prenatal_and_postnatal_care_cpg.pdf

                                           

Obstetrics and Gynecology Guidelines

 

Centers for Disease Control and Prevention (CDC) Breast Cancer Screening

https://www.cdc.gov/cancer/breast/pdf/BreastCancerScreeningGuidelines.pdf

 

CDC Cervical Cancer Screening

https://www.cdc.gov/cancer/cervical/pdf/guidelines.pdf

 

ACOG Perinatal Depression Screening

http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Perinatal-Depression

 

Edinburgh Postnatal Depression Scale

https://mccofva.com/media/3364/mva-021-magellanva-epds_postnatal_depression_survey_18shh341305_print.pdf

 

Opioid Treatment Guidelines

 

CDC Guideline for Prescribing Opioids for Chronic Pain, United States, 2016

https://www.cdc.gov/media/modules/dpk/2016/dpk-pod/rr6501e1er-ebook.pdf

 

Orthopedic Guidelines

 

American College of Physicians (ACP) Treatment of Acute and Chronic Low Back Pain

http://annals.org/aim/article/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice

 

American Society of Addiction Medicine (ASAM) National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use

http://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf?sfvrsn=24

 

Pediatric Guidelines

 

American Academy of Child & Adolescent Psychiatry Parameters, Updates and Guidelines
https://www.aacap.org/aacap/Resources_for_Primary_Care/Practice_Parameters_and_Resource_Centers/Practice_Parameters.aspx

 

Diagnosis, Evaluation, and Management of High Blood Pressure in Children and Adolescents

https://pediatrics.aappublications.org/content/142/3/e20182096

 

Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

http://pediatrics.aappublications.org/content/132/1/e262

Diagnosis and Management of Acute Otitis Media

http://pediatrics.aappublications.org/content/131/3/e964

 

Diagnosis, Management, and Prevention of Bronchiolitis

http://pediatrics.aappublications.org/content/134/5/e1474

 

The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents

https://www.nhlbi.nih.gov/files/docs/resources/heart/hbp_ped.pdf

 

Health Supervision for Children With Down Syndrome (Reaffirmed by AAP in May 2018)
http://pediatrics.aappublications.org/content/128/2/393

 

Key Points for Asthma Guideline Implementation

https://www.aap.org/en-us/Documents/medicalhome_resources_keypointsforasthma.pdf

 

Neonatal Abstinence Syndrome

http://pediatrics.aappublications.org/content/134/2/e547

 

Palivizumab (Synagis) Criteria for Respiratory Syncytial Virus (RSV) Infection

https://pediatrics.aappublications.org/content/134/2/415

 

Autism Spectrum Disorders

Identification and Evaluation of Children with Autism Spectrum Disorders
http://pediatrics.aappublications.org/content/120/5/1183

Magellan’s Adopted Clinical Practice Guidelines for the Assessment and Treatment of Children With Autism Spectrum Disorders
https://www.magellanprovider.com/media/44356/autism.pdf

American Academy of Pediatrics (AAP) Practice Guideline for the Management of Children With Autism Spectrum Disorders
http://pediatrics.aappublications.org/content/120/5/1162.full


Pediatric Attention Deficit Hyperactive Disorder (ADHD)

 

 

American Academy of Child & Adolescent Psychiatry Practice Parameter for the Assessment and Treatment of Children and Adolescents With ADHD
https://www.jaacap.org/article/S0890-8567(09)62182-1/pdf

American Academy of Pediatrics Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of ADHD in Children and Adolescents
https://pediatrics.aappublications.org/content/pediatrics/early/2011/10/14/peds.2011-2654.full.pdf

 

Preventive Health Guidelines

 

Bright Futures/AAP Periodicity Schedule

https://www.aap.org/en-us/Documents/periodicity_schedule.pdf

CDC Recommended Adult Immunizations Schedule for ages 19 years or older, 2019

https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html

 

CDC Immunization Schedule by medical conditions and other indications, 2019

https://www.cdc.gov/vaccines/schedules/hcp/imz/adult-conditions.html

 

CDC Recommended Child and Adolescent Immunization Schedule
https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

 

Interventions to Prevent Falls in Community-Dwelling Older Adults

https://jamanetwork.com/journals/jama/fullarticle/2678104

 

Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement

https://annals.org/aim/fullarticle/2480757/screening-breast-cancer-u-s-preventive-services-task-force-recommendation

 

Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement

https://jamanetwork.com/journals/jama/fullarticle/2529486

 

Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement

https://jamanetwork.com/journals/jama/fullarticle/2632511

 

Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement

https://jamanetwork.com/journals/jama/fullarticle/2680553

 

The Virginia Department of Health (VDH) Immunization Information System

http://www.vdh.virginia.gov/immunization/viis/

 

VDH Virginia Vaccines for Children Program (VVFC)

http://www.vdh.virginia.gov/immunization/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 located at https://mccofva.com/ccc-plus/for-providers/provider-handbook/. You can also find more information at the resources below.

 

EPSDT Specialized Services Guide for Providers
https://www.dmas.virginia.gov/files/links/914/EPSDT%20Specialized%20Services%20-%20Guide%20to%20Providers.pdf

 

 

American Academy of Pediatrics (AAP) Bright Futures Recommendations for Preventative Pediatric Care

https://www.aap.org/en-us/Documents/periodicity_schedule.pdf

 

Additional Resources

 

Department of Medical Assistance Services (DMAS) EPSDT Manual

https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/ProviderManual/!ut/p/z1/jY9NC4JAFEV_jct8z8Ys2o1ZCykIJNS3iZF0HPCL0ZT69UlttXq7-zj3wgGCCKgSvZKiU3UlijHH5Fz9s80tF60T7g8WcsZX3hiWeLQhfAM4cxyB_ul_Aej7fAj0C_GBZFEnHxteJWwjgXSapTrV5l2P77zrmq2BBg7DYN5K0Zq90lJVSpiy7g2cKuZ120E0WYB4lFrPSnkMAohdiFXq7DIJTXmJcEHJgz2DF1J8s-g!/dz/d5/L2dBISEvZ0FBIS9nQSEh/p0/IZ7_JP4A1B01M0EF10A3A5D01M20D3=CZ6_JP4A1B01M0EF10A3A5D01M20L4=LA0=Ejavax.servlet.include.path_info!QCPVAProviderManualsPortletView.jsp==/

 

AAP Recommendations for Preventive Pediatric Health Care

https://www.aap.org/en-us/Documents/periodicity_schedule.pdf

 

Agency for Healthcare Research and Quality

https://www.guideline.gov/summaries/summary/38256?

 

VDH Guidelines for Testing Children for Lead Exposure

http://www.vdh.virginia.gov/content/uploads/sites/20/2017/01/Guidelines-rev-2016.pdf

 

Virginia Law Protocol for Identification of Children with Elevated Blood Lead Levels

http://law.lis.virginia.gov/admincode/title12/agency5/chapter90/section215/

 

CDC Advisory Committee on Immunization Practices 2019 Immunization Schedules https://www.cdc.gov/vaccines/schedules/hcp/index.html

 

AAP Bright Futures
https://brightfutures.aap.org/Pages/default.aspx

 

American Academy of Pediatric Dentistry (AAPD) Recommendations for Pediatric Oral Health Assessment, Preventive Services, and Anticipatory Guidance/Counseling

https://www.aapd.org/assets/1/7/Periodicity-AAPDSchedule.pdf

American Academy of Family Physicians (AAFP)
www.aafp.org

 

Pulmonary Guidelines

 

Asthma
American Academy of Pediatrics- Virginia Chapter, Asthma Tool Kit and other resources

http://www.virginiapediatrics.org/asthma-tool-kit/

 

National Asthma Education and Prevention Program Asthma Care Quick Reference
https://www.nhlbi.nih.gov/files/docs/guidelines/asthma_qrg.pdf

 

Chronic Obstructive Pulmonary Disease (COPD)
Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD)

http://goldcopd.org/

Safety Guidelines

Virginia Department of Social Services Adult Protective Services (APS)

http://www.dss.virginia.gov/family/as/aps.cgi

 

Prevention of Falls in Older Persons: American Geriatric Society Clinical Practice Guidelines

https://www.seniorwholehealth.com/images/Prevention_of_Falls_in_Older_Persons_AGS_BGS_Clinical_Practice_Guideline_2010.pdf

 

Seatbelt and Helmet Safety

VDH Child Passenger Safety
http://www.vdh.virginia.gov/child-passenger-safety/

Tobacco/Smoking Cessation

Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions
https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions1

Virginia Reportable Disease List

VDH Reportable Disease List and Regulation
http://www.vdh.virginia.gov/lord-fairfax/epidemiology-program/disease-reporting/

 

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 {LINK} or eligibility {LINK} 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.

Other important resources

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.

Provider Transportation FAQ

Register for EFT today via the following link:

Provider EFT / ERA sign-up

Availity Professional and Facility Claim submission is now available. Instructions to register for the Provider portal can be found via the following link:

Availity registration

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) provider network.

ARTS map / website

Magellan Complete Care (MCC) vs. Behavioral Health Services Administrator (BHSA) Provider Quick Reference Guide.

MCC vs. BHSA Provider Guide

Community Mental Health and Rehabilitative Services (CMHRS) overview for providers. 

CMHRS Overview for Providers

Respite Care Frequently Asked Questions for providers.

Respite Care FAQ

Nursing Facilities Frequently Asked Questions for providers

Nursing Facilities FAQ