Magellan Health for Behavioral Health

Magellan Health

Magellan Health, Inc.

Magellan Health provider guide for behavioral health — Centene-owned MBHO administering commercial, Medicaid, and federal BH benefits nationwide.

Quick Reference

Payer Type

Managed Behavioral Health

Parent Company

Centene Corporation

Headquarters

Phoenix, AZ

BH Division

Magellan Healthcare

Provider Portal

Open Portal

Portal Guide

View Guide →

Credentialing

CAQH ProView

Timeline

60-120 days

Coverage

1 states

Last Verified

Apr 19, 2026

Published

Apr 19, 2026

Reading Time

11 min

Covered Levels of Care

• Medically Managed Detoxification
• Residential Treatment
• Partial Hospitalization Program (PHP)
• Intensive Outpatient Program (IOP)
• Outpatient Treatment
• Applied Behavior Analysis (Autism)

Medical Necessity Criteria

• ASAM Criteria (for substance use disorders)
• Magellan Care Guidelines (proprietary mental health and SUD criteria)

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Overview

Magellan Health is one of the three largest managed behavioral health organizations (MBHOs) in the United States, alongside Optum Behavioral Health and Carelon Behavioral Health. Magellan administers behavioral health benefits on behalf of commercial health plans, state Medicaid agencies, employers, and federal programs, and is headquartered in Phoenix, Arizona.

Magellan became a wholly owned subsidiary of Centene Corporation in January 2022, following a $2.2 billion acquisition announced in January 2021. Operationally, Magellan generally continues to function as a distinct MBHO brand with its own provider portal, clinical guidelines, and credentialing workflows, though some behavioral health functions have been gradually integrated with Centene’s broader Medicaid operations.

For treatment center operators, Magellan is particularly significant in the Medicaid behavioral health carve-out space. Many state Medicaid programs contract with Magellan to administer behavioral health benefits separately from physical health benefits, making Magellan a primary payer for substance use disorder and mental health services in those states. Magellan also holds major federal contracts, including behavioral health administration for the Department of Defense and the Federal Employees Health Benefits Program, as well as specialty contracts for autism services in several markets.

Behavioral Health Coverage

Magellan covers behavioral health services across the continuum of care, including medically managed detoxification, residential treatment, partial hospitalization programs (PHP), intensive outpatient programs (IOP), standard outpatient treatment, and Applied Behavior Analysis (ABA) for autism. Coverage specifics depend heavily on the underlying plan or contract, as Magellan administers benefits for many different sponsors, each with its own benefit structure.

Medical necessity for substance use disorder care is generally evaluated using the ASAM Criteria, while mental health admissions are generally reviewed against the proprietary Magellan Care Guidelines. In certain state Medicaid contracts, Magellan may be required to apply state-mandated criteria such as LOCUS or CALOCUS instead of its proprietary guidelines. Treatment centers should confirm the applicable criteria for each specific member before submitting authorization requests, as this determines how clinical documentation should be structured.

Because Magellan operates as a carve-out for many commercial and Medicaid plans, providers often encounter situations where the member’s medical benefits are administered by one entity while behavioral health benefits are administered by Magellan. This makes verification of benefits particularly important for Magellan members, since the claims address, authorization process, and applicable fee schedule can differ from the physical health carrier.

Credentialing and Provider Enrollment

Magellan uses CAQH ProView as the foundation of its credentialing process. Before applying to join Magellan’s network, ensure your CAQH ProView profile is complete, attested, and up to date. Applications can then be submitted through Magellan’s provider enrollment team or through the provider portal at magellanprovider.com ↗.

The credentialing timeline for Magellan typically ranges from approximately 60 to 120 days, though it can vary based on application completeness, volume, and state Medicaid-specific requirements. Delays are most commonly caused by incomplete CAQH profiles, missing facility documentation, or state-level processing backlogs. Commonly required documents include current state facility licenses, individual clinical staff licenses, professional liability insurance with adequate coverage limits, accreditation documentation (CARF or Joint Commission), DEA registrations for prescribing providers, an organizational NPI, a completed W-9, and a current program description.

For facility-level contracts, Magellan may conduct a site visit as part of credentialing, particularly for residential treatment centers, detox programs, and PHP/IOP facilities. Be prepared to demonstrate compliance with state licensing requirements, accreditation standards, and Magellan’s own facility quality standards. Recredentialing generally occurs every 36 months. Maintain your CAQH ProView attestation every 120 days and report any material changes to your facility, licensure, or staffing promptly, as specific reporting timelines may vary by contract.

Verification of Benefits (VOB)

Verification of benefits for Magellan members can be performed through the magellanprovider.com ↗ portal, by calling the Magellan provider services number on the back of the member’s insurance card, or electronically through EDI 270/271 transactions via your clearinghouse.

When verifying benefits, confirm: active coverage status and effective dates, whether Magellan is the actual behavioral health administrator (or whether benefits are carved out to a different MBHO), covered levels of care for both mental health and substance use disorders, deductible amounts and year-to-date accumulations, coinsurance or copay requirements for each level of care, out-of-pocket maximum and current status, any day or visit limitations, authorization requirements by level of care, and whether the member has out-of-network benefits.

Magellan’s plan designs vary substantially across its commercial, Medicaid, and federal contracts. Never rely on assumptions based on previous Magellan patients. Verify benefits individually for every admission and document the verification date, time, reference number, and representative name. For Medicaid managed care plans routed through Magellan, benefits are determined by the state Medicaid program and may include distinct authorization processes, covered services, and reimbursement methodologies.

Prior Authorization Requirements

Magellan generally requires prior authorization for residential treatment, partial hospitalization, intensive outpatient programs, and detoxification services, though specific requirements can vary by contract. Outpatient services often do not require prior authorization for routine psychotherapy, but some contracts have session thresholds or specific CPT code requirements that trigger review.

Authorization requests can be submitted through the magellanprovider.com ↗ portal, by fax, or by phone. The request should include a comprehensive clinical assessment, DSM-5 diagnoses, the recommended level of care with clinical justification, a treatment plan with measurable objectives, and documentation addressing all relevant ASAM dimensions for substance use disorder cases or Magellan Care Guidelines criteria for mental health cases.

Concurrent review is a standard component of Magellan’s authorization process. For residential treatment, reviews typically occur approximately every 5 to 7 days. For PHP, concurrent reviews are generally conducted every 7 to 14 days. For IOP, reviews may occur every 2 to 4 weeks. These intervals can vary by contract and clinical circumstances. Each concurrent review requires updated clinical documentation demonstrating the patient’s progress, ongoing medical necessity, and the plan for continued treatment or step-down.

If a prior authorization request is denied, request a peer-to-peer review promptly so your treating clinician can discuss the case directly with the Magellan physician reviewer. Document all peer-to-peer conversations including the date, participants, and outcome. Refer to Magellan provider resources ↗ for the most current authorization requirements.

Claims and Billing

Magellan accepts claims through electronic submission and paper submission. Electronic claims should be submitted in 837I (institutional) or 837P (professional) format through your clearinghouse. Paper claims use the UB-04 form for institutional claims and CMS-1500 for professional claims. Magellan operates multiple payer IDs across its commercial, Medicaid, and federal books of business, so confirm the correct payer ID with your clearinghouse for each specific contract.

Timely filing windows for Magellan vary significantly by contract. Commercial plans often use a 90 to 180-day filing window, while Medicaid contracts follow state-specific deadlines that can range from 90 days to a year. Federal contracts such as TRICARE and the Federal Employees Health Benefits Program have their own deadlines. Always check the applicable plan’s requirements before submitting, as claims filed after the deadline are typically denied without appeal rights.

Common denial reasons for behavioral health claims with Magellan include lack of prior authorization, medical necessity not established or documentation insufficient, timely filing exceeded, coding errors, coordination of benefits issues, and services rendered by non-credentialed providers. Magellan’s appeal process generally includes internal appeal levels, with first-level appeals typically filed within 180 days of the adverse determination, though timeframes can vary by contract and state. External review through an independent review organization is typically available after exhausting internal appeals, as required by applicable state and federal regulations.

Payer Operations Quick Reference

Magellan is an MBHO, not an insurer — it administers behavioral health on behalf of many different sponsors, so almost every operational datum (phone number, payer ID, claims address, filing limit) is contract-specific. The reliable constant is the portal: magellanprovider.com ↗ resolves the member’s contract first, then surfaces the right contacts. Confirm any value below there before relying on it.

Provider phone numbers

Phone-tree shortcuts are intentionally omitted: we only publish IVR navigation verified first-hand with a date.

Payer IDs and EDI

• There is no single Magellan payer ID — commercial carve-outs, state Medicaid contracts, and federal business each use their own IDs.
• Resolve the member’s contract first (portal or VOB call), then match it against your clearinghouse payer list; ERA/ 835 enrollment is likewise per-contract.

Timely filing limits

Cross-payer table: /denial-code-timely-filing.

Claims and appeals addresses

• Electronic first: 837P/837I via clearinghouse under the contract-correct payer ID; paper claims addresses vary by contract — use the member ID card or portal.
• Appeals: first-level appeals typically due within ~180 days of the determination (contract/state variation); the controlling address and deadline are on the denial letter. Request a peer-to-peer with the Magellan physician reviewer before or alongside the written appeal for level-of-care denials.

Credentialing contacts

• CAQH ProView ↗ + enrollment via magellanprovider.com; recredentialing every 36 months. See insurance credentialing.

Prior-auth quirks for behavioral health levels of care

Operational data last reviewed 2026-06-11; quarterly re-verification cadence applies. Compare the other “Big Three” MBHOs: Optum Behavioral Health and Carelon Behavioral Health. See /rcm for how resolves contract-specific routing automatically.

• Detox, residential, PHP, and IOP generally require prior authorization; outpatient psychotherapy often does not, but some contracts trigger review at session thresholds.
• Concurrent review cadence: roughly every 5–7 days residential, 7–14 days PHP, 2–4 weeks IOP.
• Criteria: ASAM Criteria for SUD; Magellan Care Guidelines for mental health — except where state Medicaid contracts mandate LOCUS/CALOCUS instead.
• Facility claims bill 837I/UB-04; because Magellan is a carve-out, the medical carrier’s payer ID is the wrong destination for BH facility claims — a routine misrouting that burns the filing clock.

Frequently Asked Questions

Magellan, Optum Behavioral Health, and Carelon Behavioral Health are the three largest managed behavioral health organizations (MBHOs) in the United States, often referred to as the behavioral health carve-out 'Big Three.' All three administer behavioral health benefits under contracts with commercial health plans, Medicaid agencies, and employers. Magellan generally focuses heavily on Medicaid behavioral health carve-outs, federal contracts including the Department of Defense and Federal Employees Health Benefits Program, and specialty populations such as autism services. Operationally, treatment centers should expect similar workflows across the Big Three: CAQH credentialing, authorization requirements for higher levels of care, and concurrent review using ASAM Criteria or proprietary guidelines. Always confirm which entity actually administers a member's behavioral health benefits at [magellanprovider.com](https://www.magellanprovider.com) before submitting claims.

Centene completed its acquisition of Magellan Health on January 4, 2022. Operationally, Magellan generally continues to function as a distinct MBHO brand, with its own provider portal at magellanprovider.com, its own Magellan Care Guidelines, and its own credentialing workflows. Over time, Centene has consolidated some behavioral health functions across its Medicaid plans (WellCare, Fidelis, Sunshine Health, and others), and some state Medicaid contracts may route behavioral health through Magellan while others use Centene's internal teams. Treatment centers should verify which entity manages behavioral health benefits for each specific member, as the applicable criteria, authorization process, and claims address can differ. Refer to [Magellan provider resources](https://www.magellanprovider.com) for current operational details.

Magellan primarily uses the ASAM Criteria for substance use disorder level-of-care decisions and the proprietary Magellan Care Guidelines for mental health admissions, though specific criteria can vary by plan and contract. For SUD cases, authorization requests typically must address all six ASAM dimensions and document why a lower level of care would be clinically inappropriate. For mental health, the Magellan Care Guidelines generally address symptom severity, functional impairment, risk factors, and treatment intensity required at each level of care. Some state Medicaid contracts require Magellan to use state-specific criteria (for example, LOCUS or CALOCUS in certain states) instead of proprietary guidelines. Always confirm the applicable criteria for each member's plan before submitting a request.

Magellan credentialing generally uses CAQH ProView as the foundation. Before requesting participation, ensure your [CAQH ProView](https://proview.caqh.org) profile is complete, attested, and up to date. Application and facility-level enrollment typically occur through Magellan's provider enrollment team and the [magellanprovider.com](https://www.magellanprovider.com) portal. The timeline generally runs approximately 60 to 120 days, though it can vary based on application completeness, state Medicaid requirements, and volume. Commonly required documents include state facility licenses, individual clinician licenses, professional liability insurance, accreditation (CARF or Joint Commission), DEA registrations, an organizational NPI, and a completed W-9. For facility-level contracts, Magellan may also conduct a site visit and require a program description. Recredentialing generally occurs every 36 months.

Magellan generally accepts electronic claims through standard clearinghouses using 837I (institutional) or 837P (professional) formats, as well as paper claims on UB-04 or CMS-1500 forms. Magellan operates multiple payer IDs across its commercial, Medicaid, and federal books of business, so confirm the correct payer ID with your clearinghouse for each specific member. Timely filing windows vary significantly by contract: commercial plans often use a 90 to 180-day filing window, while Medicaid contracts follow state-specific deadlines that can be as short as 90 days or as long as a year. Federal contracts such as TRICARE have their own deadlines. Always check the member's specific plan through [magellanprovider.com](https://www.magellanprovider.com) before submitting, as claims filed after the deadline are typically denied without appeal rights.

Magellan does not publish a single national provider line that covers all of its books of business — the correct number depends on the contract (commercial carve-out, state Medicaid, or federal). Use the provider services number on the member's ID card, or sign in at magellanprovider.com, which surfaces contract-specific contacts after you select the member's plan. Confirm numbers at magellanprovider.com before calling, as they change by contract.

Magellan operates multiple electronic payer IDs across its commercial, Medicaid, and federal contracts — there is no single Magellan payer ID. Identify the member's specific contract, then match it against your clearinghouse payer list or the claims-submission instructions at magellanprovider.com before submitting 837P or 837I claims.

Timely filing varies by contract: commercial carve-outs often use 90 to 180 days, state Medicaid contracts range from 90 days to a year per state rules, and federal contracts have their own deadlines. Check the member's specific plan through magellanprovider.com before submitting — late claims are typically denied without appeal rights.

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