Musculoskeletal Program

Prevea360 Health Plan works with Magellan Healthcare for review and authorization of our Musculoskeletal (MSK) Care Management Program. This includes prior authorization by the treating physician for non-emergent inpatient and outpatient musculoskeletal surgeries, specifically hip, knee, shoulder and lumbar and cervical spine.

This new program incorporates the following key components:

  • The effective date is April 1, 2019, for the following Prevea360 Health Plan product lines:
    • Commercial – Prevea360 HMO, Prevea360 POS and Prevea360 PPO
    • Dean Administrative Services Only (ASO) 
    • Prevea360 Advantage
  • Magellan’s Musculoskeletal (MSK) Care Management Program manages the medical necessity review for non-emergent inpatient and outpatient musculoskeletal surgeries through physician authorization, prior to performing the surgery.
  • Members who require the services of a provider who is not a Prevea360 Health Plan Network provider may require two authorizations. The initial authorization will need to be obtained for the use of the non-network provider via Prevea360 Health Plan Utilization Management Department.
  • Authorization may be submitted using Magellan’s website www.RadMD.com or the Magellan toll-free phone number at 877-642-0622 for procedures scheduled on or after April 1, 2019.
  • Musculoskeletal surgeries included in this program are non-emergent hip, knee, shoulder, lumbar and cervical spine surgeries. See a list of MSK-affected CPT codes.

Magellan customer service

You can contact Magellan's customer service representatives Monday through Friday from 7 am to 7 pm (CST) at 877-642-0622.

Additional MSK resources