Provider Appeals (Claim Disputes) Process

Timely file a provider appeal if you are not satisfied with the payment of a claim, denial of claim, recoupment of payment for a claim, or the imposition of sanctions regarding claims for services.

Submit your provider appeal in writing within the required timeframe. Magellan requires providers to submit appeals within 30 days of the date of the Explanation of Benefits. All provider appeals should be mailed to:

Magellan Health, Inc. Appeals and Grievances P.O. Box 83680 Baton Rouge, LA 70884-3680 Or

1-888-656-4102 (fax)

LACSoCAppeals@magellanhealth.com

What Magellan Will Do

Allow you to dispute a claim through a provider appeal after receiving the Explanation of Benefits.
Resolve and notify you in writing within 30 calendar days of receipt of your appeal.
Extend the timeframe for completing the review by up to 30 calendar days at the request of the member, provider or Magellan.
Notify you of the appeal resolution.

We will also notify you of the next steps, which is the external administrative hearing process. All requests for an administrative hearing should be mailed directly to:

Division of Administrative Law Health and Hospitals Section P.O. Box 4189 Baton Rouge, LA 70821-4189

This guidance, as well as other important information for all network providers is located within our Magellan Provider Handbooks and Supplements.

Providers