Utilization management

Utilization management

The purpose of the Magellan of Arizona (MCC of AZ) Utilization Management program is to support optimal use of healthcare services and supports for the evaluation, treatment, and integration of medical, dental and behavioral health conditions. The MCC of AZ Utilization Management and Care Management teams collaborate to ensure seamless, timely, and accurate care and service authorization processes.

The Utilization Management Department performs many functions including concurrent review, prior authorization, discharge planning assistance, retrospective review and other activities. Our Utilization Management program has the goal of optimizing the use of health care resources for our members. Services provided are not less than the amount, duration, and scope for the same services delivered to fee for service AHCCCS Medicaid members. Medically necessary services are no more restrictive than used in the AHCCCS defined program. MCC of AZ makes the utilization management criteria available in writing, by mail, or fax. MCC of AZ supports continuity and coordination of care for physical, dental, and behavioral health providers. Our members’ health is always our number one concern.

Member support services

Our Member Services staff is available to help our members if they have any questions about their benefits, services, procedures, including questions regarding utilization management or have a concern about MCC of AZ.

  • Member services staff are available Monday through Friday and members can leave a voice message during non-business hours. We suggest our members leave a voice message with their question if it can wait until the next business day.
  • Members may access Member Services by calling our toll-free number, 800-424-5891 (TTY 711).
  • Magellan Complete Care of Arizona offers no-cost interpreter services to the member. As a provider, you are required to identify the need for interpreter services for your MCC of AZ patients and offer assistance to them appropriately.

Utilization management team contact

Providers can call our toll-free number at 1-800-424-5891 with any utilization management questions:

  • Our MCC of AZ team members are available for incoming calls from 8 a.m. to 5 p.m. Arizona time, Monday through Friday
  • Our MCC of AZ team members can receive incoming calls regarding utilization management concerns after normal business hours
  • Our MCC of AZ team members can send communications out regarding questions during normal business hours, unless otherwise agreed upon
  • Our MCC of AZ team members are available to accept collect calls
  • Our MCC of AZ team members will identify themselves by name, title and our organization name of MCC of AZ when initiating or returning calls
  • Our MCC of AZ team members are available to callers who have questions about the utilization management processes
  • Providers can leave voice mail messages after business hours, 24 hours a day and 7 days a week
  • A utilization management dedicated fax line can be used to submit requests for medical necessity determinations 24 hours a day and 7 days a week
  • A utilization management dedicated email can be used to submit requests for medical necessity determinations 24 hours a day and 7 days a week