Modern Assistance utilizes Magellan Care Guidelines for the determination of Medical Necessity. These criteria are applied in the context of other critical issues, such as an individual’s psychosocial needs, desired outcomes, access to community resources, and coordination of care between behavioral health, physical health, specialty providers, and other systems of care. The goal of these criteria is to promote recovery from the symptoms of mental illness and substance use disorders and to support the member’s stabilization at the highest level of functioning.

For questions on the medical criteria used to make a level of care determination, please contact Shaun Gavin at sgavin@modernassistance.com.

Please note, Modern Assistance seeks to make placements in a level of care that is the least restrictive and most clinically appropriate service or level of care to safely, effectively, and efficiently meet the needs of the patient.

If you are an Existing Provider, please utilize our Provider Forms section for accessing the documentation necessary for obtaining initial and concurrent outpatient mental health or substance abuse authorizations.

Download Outpatient Treatment Request Form

Please complete the fillable Outpatient Treatment Program pdf and submit it via the form below. If you have questions, please contact Jen Coppellotti at jcoppellotti@modernassistance.com.