News

Overview

SOR program – Claim diagnosis requirements
Beginning March 1, 2026, any claims submitted for SOR-funded members, regardless of the date-of-service, will be administratively denied if the primary diagnosis is not opioid- or stimulant-related.

SUPTRS program - Claim diagnosis requirements
Beginning March 1, 2026, any claims submitted for Substance Use Prevention, Treatment, and Recovery Services (SUPTRS)‑funded members, regardless of the date-of-service, will be administratively denied if they do not include a primary diagnosis of a substance use disorder, with the exception of opioids or stimulants.

Provider guidance

• Providers are encouraged to review current billing practices to ensure that all claims submitted for SOR and SUPTRS members are billed with the appropriate primary diagnosis consistent with program funding requirements to avoid payment delays or denials.
• SOR funding is limited to opioid or stimulant use.
  • Examples: Use of Fentanyl, oxycodone, Percocet, heroin, and amphetamines.
• Providers must verify the type of Other State Funding (OSF), SOR or SUPTRS, for which the member has been approved and ensure the member’s diagnosis aligns with the diagnoses allowable for billing under that funding source.
  • For assistance verifying the type of OSF, please contact the Magellan Provider Line at 1-855-202-0983.

Allowable diagnoses and codes
Members covered under SOR and SUPTRS programs are authorized under their respective other state‑funded coverage based on self‑reported need for substance use treatment. Federal requirements limit the allowable diagnoses that may be billed under each program. Please review the allowable diagnosis and codes tables below.

SOR allowable diagnoses and code ranges


SUPTR allowable diagnoses and code ranges


Eligibility renewals

• Eligibility screenings are done annually.
• If criteria continues to be met, eligibility will be extended.

Questions?
If you have questions regarding these updates or need assistance, please contact your Magellan Provider Relations representative. If you are unsure who your provider relations representative is,
please reach out to the provider inbox at IdahoProvider@MagellanHealth.com.

Overview

This State Fiscal Year, Magellan has experienced increased utilization of Safe and Sober Housing (SSH) benefits. To preserve access to therapeutic services for the remainder of the fiscal year, effective Jan. 16, 2026, Magellan will no longer create new or extend existing SSH authorizations for State Opioid Response (SOR)-funded members.

SOR-funded members 24 and older currently utilizing SSH housing benefits must be transitioned out of these benefits by Feb. 16, 2026, and connected to other outpatient services. New and existing SOR-funded members between the ages of 18-24 can continue accessing SSH services until their 24th birthday. 

Both Magellan and Idaho’s Department of Health and Welfare recognize the impact this change may have on members and providers. We are committed to working collaboratively to support all parties throughout this transition.

Claims submission

Claims for SSH services for SOR-funded members, aged 24 and older, for dates of service on or after Feb. 16, 2026, will be denied. Please ensure SOR-funded members are transitioned by this date.

Provider guidance

Providers are encouraged to begin immediately supporting SOR OSF members, age 24 and older, in identifying alternative resources, including non-Magellan-funded community-based housing options. Idaho 211, which can help connect individuals to other essential community services.

Additional updates will be shared if and when SSH resources become available again for SOR-funded members.

Important reminder

SOR members will continue to have access to behavioral health outpatient services.

SOR members aged 18 until their 24th birthday have continued access to SSH services.

Please do not direct SOR members to contact Magellan to request a switch to SUPTRS funding. Funding determinations will continue to follow established eligibility criteria. Members currently eligible under SOR will not be screened for eligibility under any other category.

Thank you for your cooperation in ensuring accurate guidance for members.

In an effort to easily identify SOR funded members 24 and older, Magellan will provide SSH providers a list of members currently authorized for housing services at their facility. Please reach out to IdahoProvider@MagellanHealth.com for additional information.  

Questions?

Please contact Magellan at IdahoProvider@MagellanHealth.com.