features

Magellan provider handbooks revised for 2026

The Magellan Handbook for the National Provider Network, and the accompanying Handbook Supplement for Organizational and Facility Providers, have been revised to reflect several new policies and areas of emphasis for 2026.

Several state- or plan-specific supplements, as well as the EAP provider supplement, also have been updated recently. Visit the State-, Plan- and EAP-Specific webpage to access program-specific policies and information.

In accordance with your agreement(s) with Magellan, you should follow the policies and procedures outlined in the national handbook and any supplements that apply to plan members you serve.

Within the handbook, you’ll find information on access and availability, screening programs, clinical practice guidelines, member rights and responsibilities, care management, UM criteria, and much more.

National provider handbook updates

Here are some substantial handbook updates by section and subsection for 2026:

• Section 2, under Updating Practice Information (p. 13) re-emphasizes the importance of providers notifying Magellan to confirm changes in their administrative practice information using our online portal, at least quarterly. Providers who do not update their information or attest to its accuracy may be put “on hold” for new referrals and won’t display in the provider directories that commercial and employer plan members use to find the right provider for them.
• In Section 4, under Fraud, Waste, Abuse and Overpayment (p. 81) for increased clarity, we reorganized numerous examples of fraud, waste, abuse and overpayment.
• Also under Fraud, Waste, Abuse and Overpayment (p. 84), Magellan added detail about the process for providers to implement claims self-audits. This gives providers the tools to measure and ensure their internal compliance. The section outlines the components of a claims auditing policy, the three primary types of provider self-audits, and how to compile a comprehensive claims audit report.
• In the Electronic Claims Submission subsection under Section 5 (p. 101), the handbook introduces a newly implemented testing platform (EDI Testing Tool) for providers new to transmitting their bulk claim data to Magellan in a HIPAA-compliant 837 format via electronic data interchange (EDI).

Facility/organizational provider handbook supplement updates

• In Section 2, under Communication (p. 8), the facility/organization supplement places increased emphasis (as did the national provider handbook) on the need for providers to update and attest to their practice information at least quarterly and whenever changes in their organizational data occur. To facilitate smooth referrals, help members obtain the most current information about your organization.
• As with the individual handbook, the facility/organization supplement highlights (in Section 5 under Electronic Claims Submission, p. 24) the online location and contact information for our enhanced EDI Testing Tool to prepare for bulk e-submission of provider claims.
• Appendix B – What You Need to Know About Organization Credentialing and Contracting (p. 27): This FAQ section includes a question about the typical timeframe for the credentialing process. Whereas the standard answer to this question previously was 90 days, the updated response explains that the credentialing process can be completed substantially more quickly provided the facility/organization’s submitted application is complete and current, and the facility/organization supplies all required documentation within the requested timeframe.

Note that updates to Medical Necessity Criteria Guidelines also occur annually. Visit www.MagellanProvider.com/mnc.