Appeals and Claim Disputes

Magellan is committed to ensuring that providers have an avenue with us to dispute a claim outcome through an appeal process. We review provider appeals regarding payment of a claim, the denial of a claim, the recoupment of a payment of a claim and the imposition of sanctions.

Read more about the Provider Appeals process.

Clinical Appeals

Magellan supports the right of members, and their providers acting on the member's behalf, to appeal adverse clinical determinations.

Our customer organizations and applicable federal and state laws impact the clinical appeals process. Therefore, the procedure for appealing a clinical determination is outlined fully in the Notice of Action (non-authorization) letter.

Read more about the Clinical Appeals process.

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