Providers must be credentialed through Magellan to provide, bill services
“It might be common practice, but billing for sessions conducted by an intern is not permitted under your Magellan provider contract,” stated senior vice president of Network, Eric Schmitz.
Recently, Magellan’s Special Investigation Unit (SIU) has reported several cases involving unethical billing practices by providers.
According to the Magellan National Provider Handbook, “As a matter of value and quality, we promise our [health and employer plans] customers that only participating providers that meet Magellan’s credentialing and contracting standards will deliver services to benefit-eligible members.”
If your practice includes interns who are not yet licensed or credentialed, keep in mind that they may not provide reimbursable services to Magellan members.
The provider name on the claims must match the name of the person providing the service, and this person must be fully credentialed with Magellan. When we note discrepancies between the two names, the case will be flagged for investigation.
Magellan appreciates your being part of our network; keep those credentialing applications for new providers coming!
Thank you for helping us ensure that Magellan members receive quality services.
- Review Magellan’s policy on sub-contracting in Section 2 of the Magellan National Provider Handbook (PDF) and FAQs about credentialing in the appendices.
- If you suspect someone of unethical billing practices, contact the SIU via email (SIU@MagellanHealth.com) or via our hotline 1-800-755-0850 (you may remain anonymous).
- If you have other questions, reach out to your Magellan network representative.