How do I submit a claim?
In-network providers

• When you use an in-network provider, they will submit the claim directly to Magellan on your behalf.
• If you receive a Magellan referral, your provider will complete and submit the appropriate claim form to be reimbursed for your care.
• You do not need to submit a claim or call for outpatient authorization.

Out-of-network providers

• Out-of-network providers are not required to process and submit your claims.
  

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 1-800-513-2611 (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.
Appeals must be initiated within 60 days of Magellan's denial of your initial claim and the limits outlined in the correspondence must be adhered to.
Magellan will have previously reviewed your medical records for any claim requiring a medical determination. If Magellan denies a claim for medical reasons, you may request verbally or in writing that Magellan review the claim.
If you are not satisfied with the results of the review, you may file a written appeal to Magellan. The appeal must be written and include your full name, the enrollee’s identification number (indicated on your membership card), the date of the service, the name of the provider for whose services payment was denied, and the reason you think the claim should be paid. You are responsible for providing Magellan with all information necessary to review the denial of your claim. Magellan will review your appeal and respond within 60 days of Magellan’s receipt of all information necessary to make a decision.

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

Fax Number:1-888-656-3820

Members needing Assistance in filing appeals: 1-800-201-3957