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

region/plan-specific news : District of Columbia Medicaid

Got appeals? Four ways to submit them to Magellan

Whether it was a service that did not meet medical necessity or a claim that denied, Magellan manages all enrollee and provider appeals for MedStar Family Choice District of Columbia Health Plan behavioral health services.

  • For clinical appeals, submit within 60 calendar days of the denial.
  • For claims appeals, submit within 90 business days of denial letter date or EOB.

Submit the written request, outline the reason for the appeal, and include necessary documentation.

Choose ONE of the following methods of submission:

  1. U.S. Mail: Attn: Appeals Department, Magellan Healthcare, P.O. Box 1718, Maryland Heights, MO 63043
  2. Fax: 1-888-656-5712
  3. Upload on provider website: www.MagellanProvider.com (after sign in, select Submit an Appeal/Dispute Document from the left-hand menu)
  4. Phone: 1-800-777-5327 (clinical appeals only)

Magellan will make the decision about an appeal within 30 calendar days. Expedited clinical appeal decisions will be made within 72 hours. Claims appeals are not eligible for expedited review.

Questions?

If you have any questions about this process, contact us at DCProviderNetwork@MagellanHealth.com.

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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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