Claims/Payment-Related Forms

Electronic Payment Is Required Effective July 1. If you are not currently receiving payments via electronic funds transfer (EFT), please sign up as soon as possible. EFT is a fast, secure and environmentally friendly method to receive payments directly into your bank account.

Complete and submit this form to Magellan to request that your claims payments be directly deposited to your business bank account.

Authorization Agreement for Electronic Funds Transfer (EFT)

If you use a clearinghouse, complete this form and contact the clearinghouse to sign up for ERA, which is the electronic method for providers to receive Explanation of Benefits (EOB), Explanation of Payment (EOP) and claims denial information.

Electronic Remittance Advice (ERA) Registration or Termination For providers using a clearinghouse

If you submit claims directly to Magellan, complete this form in order to register / terminate for your Electronic Remittance Advice ERA).

Electronic Remittance Advice (ERA) Registration or Termination For providers submitting directly to Magellan

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Providers