File a claim
This claim form should be submitted when a patient
receives services from an out-of-network provider
who requests the patient submit reimbursement to
their own insurance company.
Your provider should give you a statement of services
that contains the following items in order for
Magellan to consider this claim as complete. You will
file this claim by providing some personal identifying
information and uploading your supporting
document, including an itemized billing statement.
Click here for a sample provider statement.
If you have questions about any of the following
items, please call Magellan for assistance.