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

region/plan-specific news : District of Columbia Medicaid

You could be due for recredentialing

What to do NOW

It’s hard to believe, but it’s been nearly one year since Magellan began managing behavioral health benefits for MedStar Family Choice District of Columbia. Thank you for joining the network to provide services to DC Medicaid enrollees in this program!

Magellan providers must successfully complete the credentialing review process prior to being accepted as a network provider and the recredentialing process every three years unless otherwise required by applicable state and federal law, a customer, and/or an accrediting entity.

If your recredentialing due date is approaching, you can take steps now to maintain your in-network status with Magellan to continue caring for MedStar Family Choice DC enrollees.

If you are a clinician affiliated with a group practice:

Remember: Magellan does not credential at the group practice level. However, clinicians within the group must complete the individual credentialing process to provide covered services to Magellan members.

  • Log on to CAQH at http://proview.caqh.org and complete your application, sending all required documents to CAQH. Ensure that you have re-attested to your information and have authorized Magellan to access your application. Best practice: Attest to your data every 120 days.

If you are with an organization/facility:

  • Respond when you receive the recredentialing application for your organization. We mail this to the mailing address on record six months prior to the credentialing anniversary.
  • Notify Magellan about new locations that will be serving MedStar Family Choice DC members. Not only must new locations be added to the contract, but they must also be credentialed before being considered an in-network location.

Not meeting recredentialing timeframes is the most common reason for involuntary termination from the network.

Learn more

Find more information about recredentialing and other policies in our MedStar Family Choice DC provider orientation (PDF), as well as in the frequently asked questions – Credentialing and Contracting (found in our Appendices to the National Provider Handbook).

Questions?

If you have any questions about the credentialing or recredentialing requirements for being in the Magellan network for DC Medicaid, email 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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