Quality

Magellan Complete Care of Arizona (MCC of AZ)’s quality management (QM) program is built on a well-rounded process to monitor and evaluate the quality of our MCC of AZ services. The quality management program addresses appropriateness, efficiency, safety and effectiveness of care and service for our members to ensure they receive the care they deserve.

MCC of AZ aims to focus on opportunities for continuous improvement, providing not only adequate supports for our members but also our providers. Our quality management program works to ensure that all care is required for our members on a timely basis and all needs from physical health to behavioral health are being met. MCC of AZ holds all staff, providers and contracted entities accountable for quality, promoting a culture of quality throughout our organization and network.

The quality management program addresses all issues related to quality management and quality performance measures to ensure both AHCCCS and federal compliance. In an effort to maintain and exceed quality standards, MCC of AZ provides resources for preventive care guidelines, HEDIS, quality of care reporting requirements and education, member satisfaction, access and availability.

If you would like more information around the MCC of AZ quality management program, please send an email to MCCAZQuality@MagellanHealth.com.

Reporting quality of care concerns and IADs

The AHCCCS QMS portal is used to report quality of care (QOC) concerns and IADs as they occur. As a contracted MCC of AZ provider, please use the QMS portal to report any QOC or IAD incidents that you encounter.

Please refer to the quick start guide to register for the AHCCCS QMS portal.

Portal Instructions: Please refer to the quick start guide for submitting a QOC or IAD once you are registered and have access to the AHCCCS QMS portal.

Reporting seclusion and restraint incidents

State-licensed behavioral health inpatient facilities (BHIF) and mental health agencies, including out-of-state facilities that are authorized to use seclusion and restraint (S&R) must report all incidents of S&R to MCC of AZ at the time the incident occurs. Please download the seclusion and restraint reporting form for each individual incident and email the form to MCCAZQuality@MagellanHealth.com.

2020 quality performance guide

The MCC of AZ quality team has created the 2020 quality performance guide to help all provider offices achieve their best possible HEDIS®, CAHPS® and Coding Accuracy results. We hope that this resource becomes a guide and asset to you and the team within your office.

MCC of AZ clinical practice guidelines

Magellan Complete Care of Arizona (MCC of AZ) uses nationally accepted, evidence-based criteria, developed by specialty organizations, national policy committees (clinical practice guidelines) and/or industry recognized review organizations in addition to state or federal criteria or regulations (as appropriate), medical policy or internally developed criteria, physician and clinical judgment to evaluate the necessity of medical and behavioral health services.

MCC of AZ has adopted evidence-based clinical practice guidelines or protocols for a wide variety of medical conditions and services delivered in different medical and/or behavioral health settings. MCC of AZ has adopted MCG evidenced –based clinical practice guidelines for management of medical, behavioral, home health, and nursing facility services.

Medical criteria is approved and reviewed annually by the MCC of AZ medical management committee and national policy committee. In accordance with 42 CFR §438.236 MCC of AZ utilizes ASAM criteria for medical necessity determinations for addiction and recovery services. MCC of AZ utilizes proprietary diagnostic services criteria for imaging, sleep studies and certain pain management procedures. These criteria sets are based on sound scientific evidence for recognized settings of care and used to decide the medical necessity and clinical appropriateness of services. If state law requires additional criteria, it is adopted into policy and used.

MCC of AZ adopts practice guidelines that meet the following requirements:

  • Are based on valid and reliable clinical evidence or a consensus of health care professionals and service providers in a particular field;
  • Consider the needs and preferences of the members;
  • Are adopted in consultation with providers; and
  • Are reviewed and updated periodically, as appropriate.

MCC of AZ disseminates any revised practice guidelines to all affected providers and, upon request, to members and potential members. The practice guidelines provide a basis for consistent decisions for utilization management, member education, coverage of services, and any other areas to which the guidelines apply.

Information on clinical practice guidelines approved by AHCCCS, MCC of AZ’s committee and other health organizations.

* The external links are being provided as a convenience and for informational purposes. Such materials should be treated as educational resource(s) to provide clinical practice recommendations, components of proper care, general treatment guidelines, and/or used to increase knowledge, and promote better management of patients. This information should not be considered as inclusive of all proper treatments or methods of care, and is not intended to substitute for the independent professional judgment of the treating clinician.