features

Providers must be credentialed through Magellan to provide, bill services

It might be common practice, but billing for sessions conducted by an intern generally is not permitted under most Magellan provider contracts.*

According to the Magellan National Provider Handbook, “As a matter of value and quality, we promise our [health and employer plan] customers that only participating providers that meet Magellan’s credentialing and contracting standards will deliver services to benefit-eligible members.”

If your practice includes interns who are not yet licensed or credentialed, keep in mind that they may not provide reimbursable services to Magellan members.

The provider name on a claim must match the name of the person providing the service, and this person must be fully credentialed with Magellan. When we note discrepancies between the two names, the case will be flagged for investigation.

Magellan appreciates your being part of our network; keep those credentialing applications for new providers coming! 

Thank you for helping us ensure that Magellan members receive quality services.

More information

• Review Magellan’s policies on sub-contracting in Section 2 and fraud, waste and abuse in Section 4 of the Magellan National Provider Handbook (PDF), as well as FAQs about credentialing in the appendices.
• If you suspect someone of using unethical billing practices, contact the SIU via email (SIU@MagellanHealth.com) or via our hotline 1-800-755-0850 (you may remain anonymous).
• If you have other questions, reach out to your Magellan network representative.

*Regulations in some states do allow for intern-provided services and billing (e.g., CA SB 855).