Getting Paid - EAP Services Application
What’s on this page
Getting Paid
Tap into tools and resources to help you get paid accurately and promptly for the services you provide to members.
What’s on this page
Preparing Claims
Magellan Health offers a secure, real-time platform for providers to prepare and submit their claims online. We prefer that providers submit electronically for speed and ease of use. You may employ the Availity Essentials Portal to submit claims online and check their status.
Availity Essentials
Claims Filing Procedures
Our claims filing procedures are listed in detail in Section 5 of the Magellan National Provider Handbook (PDF).
Under Magellan's policies and procedures, the standard timely filing limit is 60 days (with a few state/plan exceptions).
DSM-5/ICD-10
DSM-5
The American Psychiatric Association (APA) released the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5®) in May 2013.
DSM-5 recommends scientifically validated assessment measures, rating scales in diagnosis, monitoring and measuring treatment progress, and assessing impact of culture in key aspects of clinical presentation and care.
Find additional information on DSM-5 on the APA's website.
DSM-5 recommends scientifically validated assessment measures, rating scales in diagnosis, monitoring and measuring treatment progress, and assessing impact of culture in key aspects of clinical presentation and care.
Find additional information on DSM-5 on the APA's website.
ICD-10
To maintain HIPAA compliance on claim submissions, providers must use ICD-10 diagnosis codes. This is a federal government mandate.
ICD-10 Information and Resources
ICD-10 Information and Resources
HIPAA Coding
HIPAA mandates that all electronic transactions include only HIPAA compliant codes; therefore, Magellan requires the use of HIPAA compliant codes on all claims. Claims with non-compliant codes will be rejected and returned to you for correction before processing.
Review the following HIPAA compliant coding guidelines.
Review the following HIPAA compliant coding guidelines.
Electronic Transactions
Magellan highly encourages providers to submit claims electronicly. Please take advantage of our three methods for electronic submision and learn more about submitting your claims and receiving payment digitally.
- Submitting Transactions and Claims
- Claims Courier
- Direct Submit
- Clearinghouses
- Clearinghouse contact information
- Electronic Funds Transfer (Direct Payment)
- National Provider Identifier (NPI)
- Frequently Asked Questions
Paper Claim Forms
Providers have the option to submit claims via paper forms, but we encourage you to submit forms electronically. Doing so allows for faster processing and gives us the ability to identify errors earlier, which drastically reduces the likelihood that your claims will be rejected or denied for payment.
Employee Assistance Program (EAP) Reimbursement
Find information about EAP Reimbursement in section 7 of the EAP Handbook Supplement (PDF).
EFT for EAP payments
Use this EAP EFT Form (PDF) to enroll for electronic funds transfer to your bank account.
Note that if you also serve non-EAP members, you'll need to enroll via an additional method to receive those payments via EFT; see our EFT ("Direct Deposit") section for links. Find information about EAP Reimbursement in section 7 of the EAP Handbook Supplement (PDF).
EASI Form
You must submit the EASI Form within 90 days of the end date indicated on the referral sheet, found in the EAP member registration packet for each specific case. Please refer to the EAP registration packet for the specific billing address.
EFT for EAP payments
Use this EAP EFT Form (PDF) to enroll for electronic funds transfer to your bank account.
Note that if you also serve non-EAP members, you'll need to enroll via an additional method to receive those payments via EFT; see our EFT ("Direct Deposit") section for links. Find information about EAP Reimbursement in section 7 of the EAP Handbook Supplement (PDF).
EASI Form
You must submit the EASI Form within 90 days of the end date indicated on the referral sheet, found in the EAP member registration packet for each specific case. Please refer to the EAP registration packet for the specific billing address.
Submit an Appeal/Dispute Document
For non-urgent appeals/disputes:
Click here to upload supporting documents to pertaining to the denied authorization or claim.
For urgent and expedited appeals/disputes: Contact the appropriate toll-free number for the member’s program; do not submit the information here.
For public sector plans: Follow the local program’s process for appeals and disputes; do not submit the information here.
Click here to upload supporting documents to pertaining to the denied authorization or claim.
For urgent and expedited appeals/disputes: Contact the appropriate toll-free number for the member’s program; do not submit the information here.
For public sector plans: Follow the local program’s process for appeals and disputes; do not submit the information here.
FAQs
Magellan Health offers a secure, real-time platform for providers to prepare and submit their claims online. We prefer that providers submit electronically for speed and ease of use. You may employ the Availity Essentials Portal to submit claims online and check their status.