This is the Magellan website for behavioral health providers
Magellan Health

Paper Claim Forms*

 

We encourage providers to submit electronic claims, which allows for earlier detection of errors, drastically reducing the likelihood of claims being rejected or denied for payment, and often results in faster processing.

CMS-1500

For non-facility-based professional services

For more information about the CMS-1500 form, visit the National Uniform Claim Committee’s website. Note that Magellan can only accept the current version of the CMS-1500 form.

UB-04

For facility-based professional services

For more information about the UB-04 form, visit the National Uniform Billing Committee’s website. Contact your claim forms vendor to obtain full-color versions of the UB-04.

Magellan’s EASI Form

For EAP reimbursement

To receive payment for Employee Assistance Program (EAP) services rendered, you must complete and submit the Employee Assistance Service Information (EASI) Form.

 

*For your protection, California law requires the following to appear on this form. Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.