How do I submit a claim?

The covered person does not need to file a claim form when an in-network provider is used.

Submission of a claims form is required when treatment is received from an out-of- network provider.

The following steps must be completed when submitting bills for payment:

1. Get a claim form from Magellan by calling toll free 888-213-5125. If the requested claim form is not received within 15 calendar days, the covered person can file a claim by sending the bills with a letter addressed to Magellan. Out- of- network claims should be mailed to Magellan, P. O. Box 1098, Maryland Heights, MO 63043. (The claim form is also available on the Benefits Home Page)
2. Complete the employee portion of the form
3. Have the provider complete the provider portion of the form
4. Send the form and bills to the address shown on the form

Make sure the bills and the form include the following information:

• The employee’s name and identification number (either Social Security Number or Alternative ID number)
• The employer’s name (Maricopa County)
• The patient’s name
• The diagnosis
• The date the services or supplies were incurred
• The specific services or supplies provided

When Claims Must be Filed

The covered person must file a claim with Magellan, including written proof of loss, within 12 months after the date the expenses are incurred.

Magellan will determine if enough information has been submitted to enable proper consideration of the claim. If not, more information may be requested.

 

How do I file a complaint or appeal?

Complaint

If you have a complaint about the care or services you received, please call Magellan directly.

Magellan uses First Call Resolution to resolve concerns at the time of each member’s call; however, if you are not satisfied with the outcome you may submit complaints verbally or in writing.

Complaints are acknowledged within 24 business hours and resolved within 30 calendar days.

Call 1-800-537-5221 (press 1, then press 2)

Write

Magellan Health Services
Attention:  Complaints/MO41
14100 Magellan Plaza
Maryland Heights, MO 63043

Appeal

You have the right to request Magellan to review the denial or payment of any claim. When a claim is denied the correspondence to the member includes information about the limits for each stage of the appeal.

Your appeal request must be submitted to Magellan within 180 calendar days after you receive the utilization review or claim denial decision.

If you are not satisfied with the first level appeal decision, you have the right to request a second level appeal. Your second level appeal request must be submitted to Magellan within 60 calendar days from receipt of the first level appeal decision.

 

Administrative and Clinical appeals

Magellan Appeals Department
P.O. Box 2128
Maryland Heights, MO 63043

Please refer to the behavioral health section of the Summary Plan Description for in depth appeals instructions and information.