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.
Training resources
- Authorization System (55:41) and presentation deck (PDF) June 2024
- Authorization submissions – Presentation deck (PDF)
- Inpatient providers: Overview of Authorizations (4:12)
- Residential providers: Overview of Authorizations (4:52)
- Upcoming live training sessions