The new Idaho Behavioral Health Plan (IBHP) will transform and improve Idaho’s behavioral healthcare system by coordinating behavioral health benefits for Idaho residents. Services will be managed by Magellan Healthcare, Inc. beginning July 1, 2024.
The new IBHP contract is structured differently than the previous one because a managed care provider, Magellan Healthcare, Inc., will manage behavioral health services for the Divisions of Behavioral Health and Medicaid. Magellan will also manage the provider network for the Department of Juvenile Corrections. Magellan will oversee behavioral health services for Idahoans who have Medicaid, other types of insurance, and who don’t have insurance. Because outpatient behavioral health services will be included in the plan, the Division of Behavioral Health (DBH) will no longer offer outpatient behavioral health services.
On July 1, 2024, Magellan will begin managing services for the IBHP. Here are some important things for providers to know.
- Magellan will honor all authorizations from BPA, Telligen, and Optum that have been approved and span past July 1, 2024. The end date of the authorization will be the same as what Optum, Telligen, and BPA told your provider.
- A member in active treatment with an out-of-network provider may continue receiving services from that provider for the first 90 days after July 1, 2024, and Magellan will cover the services.
- Tribal members in active treatment with Indian healthcare providers may continue receiving services from that provider for as long as they need to, and Magellan will cover the services.
Submitting authorization requests
- June 30, 2024, and prior, submit requests to BPA Health, Optum, or Telligen through currently approved processes.
- Beginning July 1, 2024, submit requests to Magellan at MagellanofIdaho.com. Refer to Magellan’s Provider Handbook for options to submit claims.
Filing claims
- Claims for outpatient services and recovery support:
- Claims for services rendered through 11:59 p.m. MT on June 30, 2024: Submit to BPA Health, Optum, or Telligen.
- Claims for services rendered beginning 12:00 a.m. MT on July 1, 2024: Submit to Magellan at MagellanofIdaho.com. Refer to Magellan’s Provider Handbook for options to submit claims.
- Claims for inpatient and residential services:
- For stays with discharges up through 11:59 p.m. MT on June 30, 2024: Submit claims to BPA Health, Optum, or Telligen.
- For stays with admission up through 11:59 p.m. MT on June 30, 2024, and discharge starting at 12:00 a.m. MT on July 1, 2024:
- For DRG reimbursement, submit claims for the full stay to BPA Health, Optum, or Telligen.
- For per diem reimbursement:
- For services up through 11:59 p.m. MT on June 30, 2024: Submit claims to BPA Health, Optum, or Telligen.
- For services from 12:00 a.m. MT on July 1, 2024, and beyond: Submit claims to Magellan at MagellanofIdaho.com. Refer to Magellan’s Provider Handbook for options to submit claims.
FAQ
Idaho has awarded a contract to Magellan Healthcare, Inc. who will take over managing behavioral health services and coordinating care for Medicaid and non-Medicaid members.
- For questions about an authorization or claim with a service start date before July 1, 2024, contact BPA Health, Optum, or Telligen using the current process.
- For questions about authorizations, claims, or provider questions, with a service start date after July 1, 2024, contact Magellan’s provider line at 855-202-0983.
- Visit Magellan’s frequently asked questions for more FAQ.
Magellan will begin managing the IBHP on July 1, 2024.
The new IBHP affects providers for all behavioral health services for the Divisions of Behavioral Health and Medicaid. Magellan will also manage the provider network for the Department of Juvenile Corrections.
Magellan will not “grandfather” providers from other networks. If you would like to join Magellan's network or have questions, visit Magellan of Idaho's website.
A managed care organization (MCO) is an organization that helps you manage your health. Idaho's new MCO for behavioral health is Magellan Healthcare, Inc. Magellan will help you get the services you need by coordinating care and providing behavioral healthcare services through a network of providers.
The Magellan Provider Handbook describes the services and reimbursement rates that are covered through the IBHP.
- In developing the new Idaho Behavioral Health Plan (IBHP), the Department identified there is a significant gap in intensive care coordination (ICC) services available for both youth and adults.
- To increase capacity, our approach is to transform Targeted Care Coordination (TCC) offered today solely by community providers into a model with Intensive Care Coordination (ICC) as an administrative service provided by Magellan, and Idaho Wraparound Intensive Services (Idaho WInS) and Case Management services offered through IBHP network providers.
- This approach is intended to:
- Standardize member care for intensive care coordination.
- Improve Service Delivery.
- Reduce Hospitalizations.
- Enhance Intensive service needs, identification, and coordination.
- Increase engagement with youth in Psychiatric Residential Treatment Facilities and Residential Treatment Centers and their families.
- Improve Multi-system coordination (Idaho Department of Juvenile Corrections, Children's Developmental Disabilities, Family and Community Services, Medicaid, Idaho Courts).
- Provide statewide access to ICC for adults and youth and Idaho WInS for youth who meet medical necessity criteria.
- Alleviate concerns with CMS for duplication of service.
- Alleviate concerns with CMS for conflict free case management.
- Enhance and expand case management services which can work alongside ICC and Idaho WInS in the new care model.
- Standardize member care for intensive care coordination.
- To promote a smooth transition, providers will be able to continue to serve existing members receiving TCC service and bill for TCC services through 12/31/2024. This will provide Magellan 6 months to work with you to transition members to the new ICC services and to begin offering Idaho WInS within the network.
- The Department and Magellan will work with providers performing TCC services as we continue to expand the IBHP network to discuss how their role will be changing in the new IBHP as well as other opportunities for them to provide services to Medicaid and other eligible IBHP members.