Provider Handbook - Provider Portal
Handbook Supplements
Provider Handbook
The Magellan National Provider Handbook outlines the policies and procedures with which providers are required to comply when serving members whose care is managed by Magellan and/or its affiliated companies.
Providers also must comply with the policies and procedures contained in any applicable handbook supplements, including the Magellan Organizational Provider Handbook Supplement, and state-, plan- or EAP-specific supplements.
Handbook Supplement
Provider Handbook
The Magellan National Provider Handbook outlines the policies and procedures with which providers are required to comply when serving members whose care is managed by Magellan and/or its affiliated companies.
Providers also must comply with the policies and procedures contained in any applicable handbook supplements, including the Magellan Organizational Provider Handbook Supplement, and state-, plan- or EAP-specific supplements.
Handbook Appendices
- Professional Provider Selection Criteria for Individual Providers (PDF)
- Magellan Clinical Practice Guidelines
Frequently Asked Questions - Credentialing and Contracting
- Individual Credentialing and Contracting (PDF)
- Group Provider Credentialing and Contracting (PDF)
- Recredentialing (PDF)
Rights and Responsibilities
- Member Rights and Responsibilities -- English (PDF)
- Member Rights and Responsibilities -- Spanish (PDF)
- Medicaid Enrollee Rights and Responsibilities -- English (PDF)
- Medicaid Enrollee Rights and Responsibilities -- Spanish (PDF)
Audit Tools
- Treatment Record Documentation Worksheet (PDF)
- Major Depressive Disorders/Suicide Management Clinical Practice Guideline Audit Tool (PDF)
- Substance Use Disorder/Suicide Management Clinical Practice Guideline Audit Tool (PDF)
- Attention Deficit Hyperactivity Disorder Clinical Practice Guideline Audit Tool (PDF)
Fraud and Abuse Compliance Policies
- Medicaid: Program Integrity and Compliance Program Policy (PDF)
- Medicare Advantage: Compliance Program Policy (PDF)
- False Claims Laws and Whistleblower Protections Policy (PDF)
Claims
- Coordination of Benefits (PDF)
- Elements of a Clean Claim (PDF)
- Claim "Dos" (PDF)
- Claim "Don'ts" (PDF)