Initiating Care

Providers should verify member eligibility for requested services before rendering care.

Log in to the Availity Essentials portal or contact Magellan at 1-855-202-0983 to obtain a member’s eligibility and benefits. 

To request an authorization for services (when required), log in to the Availity Essentials portal and click the Authorizations tile in the Magellan Healthcare Idaho Payer Space. You may also submit a request via fax. See the Provider Forms page. Contact Magellan at 1-855-202-0983 with questions about authorizations.

Services Requiring Prior Authorization

Service Name  Medicaid Covered Service Service Paid Through Other Funding**   Medical Necessity Criteria  Prior Authorizations, Threshold Authorizations, or Notification of Admission (NOA) 
Inpatient (acute, subacute facilities and IMDs)  YES YES MCG NOA
Residential Treatment – PRTFs, RTCs, IMDs  YES YES MCG Prior Authorization 
ASAM 4.0  YES NO ASAM NOA
ASAM 3.7  YES YES ASAM NOA
ASAM 3.5  YES YES ASAM NOA
Partial Hospitalization  YES YES MCG Prior Authorization
Partial Hospitalization SUD ASAM 2.5  YES YES ASAM Prior Authorization
IOP – Intensive Outpatient Program/ASAM 2.1  YES YES ASAM No authorization requirement 
IOP – Intensive Outpatient Program/Mental Health  YES YES N/A No authorization requirement 
Electroconvulsive Therapy (ECT)  YES YES MCG Prior Authorization
Transcranial Magnetic Stimulation (TMS)  YES YES MCG Prior Authorization
Child Day Treatment  YES YES MCG Prior Authorization
Psychological / Neuropsychological Testing YES YES IBHP Supplemental MNC Prior Authorization after threshold of 14 hours per member per calendar year 
Respite  YES NO N/A Hard cap threshold of 300 hours per calendar year 
Health & Behavior Assessment and Intervention (HBAI)  YES YES HBAI Billing and Coding Guide  Prior Authorization after threshold of 60 units per member per calendar year 
Homes with Adult Residential Treatment (HART)  YES YES IBHP Supplemental MNC Prior Authorization
HART 1:1 Supervision NO* YES IBHP Supplemental MNC Prior Authorization
Assertive Community Treatment (ACT)  YES YES MCG Prior Authorization
Parenting with Love and Limits (PLL)  YES YES IBHP Supplemental MNC Prior Authorization after threshold of 12 weeks per calendar year 
Wraparound   YES YES IBHP Supplemental MNC NOA 
CBRS (Skill Building/Community Based Rehab services)  YES YES IBHP Supplemental MNC Prior Authorization after threshold of 308 units. 
Case Management for Behavioral Health  YES YES MCG Prior Authorization after threshold of 240 units per member per calendar year 
Case Management for SUD - Basic and Intensive  NO* YES N/A No authorization requirement 
Adult Peer Support  YES YES IBHP Supplemental MNC Prior Authorization after threshold of 416 units per member per calendar year 
Youth Peer Support  YES YES IBHP Supplemental MNC Prior Authorization after threshold of 416 units per member per calendar year 
Family Support  YES YES IBHP Supplemental MNC Prior Authorization after threshold of 416 units per member per calendar year 
Recovery Coaching  YES YES IBHP Supplemental MNC Prior Authorization after threshold of 416 units per member per calendar year 
Behavioral Health Modification and Consultation  YES YES IBHP Supplemental MNC Prior Authorization
Alcohol and Drug Testing  YES YES N/A Prior Authorization after threshold of 24 units/tests per member per calendar year 
Intensive Home and Community Based Services - Multisystemic Therapy (MST) Multidimensional Family Therapy (MDFT) Functional Family Therapy (FFT) Family Program (FP)  YES YES IBHP Supplemental MNC Prior Authorization
Early and Serious Mental Illness (ESMI)  YES YES IBHP Supplemental MNC NOA 
Basic Housing Essentials  NO* YES IBHP Supplemental MNC Prior Authorization
Adult Safe and Sober Housing NO* YES IBHP Supplemental MNC Prior Authorization
Enhanced Adult Safe and Sober Housing NO* YES IBHP Supplemental MNC Prior Authorization
Child Care for SUD NO* YES IBHP Supplemental MNC Prior Authorization

*Paid only through other state funding and not through Medicaid funds. These benefits are funded through the Idaho Department of Health and Welfare. Funding is limited and may only be used until funding has run out.
**Other funding excludes 638 funding. 

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