Magellan Healthcare
Provider Focus Newsletter
News & information for Magellan network providers

region/plan-specific news : Commercial Health Plans in DC, DE, FL, IL, MD, MI, NC, NJ, OK, PA, TX, VA

Serving Medicaid or CHIP members? Enroll with the state Medicaid agency for these programs

If you contract with Magellan as a Medicaid or CHIP participating provider, you must also be enrolled with the state Medicaid and/or CHIP program. The rules for these plans vary by state, but noncompliance could impact your Magellan claims reimbursement or lead to administrative action.

Enrollment

To be active in Magellan’s Medicaid and CHIP networks, you must have a National Provider Identifier (NPI), meet your state’s eligibility criteria, and be approved for re-enrollment in these state programs. Per the Affordable Care Act of 2010 enrollment requirements, providers must enroll or re-validate with the state program at least every three to five years, depending on the provider type. It is your responsibility to review the Medicaid and CHIP enrollment requirements and timelines for your state and follow them accordingly.

Reimbursement

To be paid for services you render to Magellan Medicaid and CHIP members, you must be actively enrolled in your state’s Medicaid and/or CHIP programs.

Data validation

Be sure you notify both the state and Magellan of any changes to your contractual or demographic information. Failure to provide this information could lead to a delay in processing claims, denial of claims, or to administrative action, as appropriate.

 

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About Provider Focus

Welcome to Provider Focus, our award-winning e-newsletter for network providers! Here you’ll find articles and information to keep you up-to-date on news and topics relevant to serving Magellan members, including a section for regional- and plan-specific news. Check back as a new issue is released each quarter.

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