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Alaska Medicaid / Prior Authorization Request Form Prescriber Use Only Fax this request to 888 603-7696 Questions Call Magellan Medicaid Administration at 800 331-4475 Or mail this request to Medicaid PA Unit 14100 Magellan Plaza Maryland Heights MO 63043 Form available http //dhss. alaska*gov/dhcs/Pages/pharmacy/medpriorauthoriz. aspx Note / Product PA s can only be requested using this form* Approval does not ensure eligibility. Please verify Medicaid eligibility before completing this form* REQUESTOR RECIPIENT Must be requested by prescriber. See below. Requestor Name Print Last Name First Name Middle I. DOB Medicaid ID mm/dd/yyyy 10-digits PRESCRIBER Name Revised 1-2013 Phone Sex Male Female NPI Fax Specialty DEA Doses 3 units per day OR 24 mg per day will NOT be approved* Only 1 strength of 1 product will be authorized for use at a given time. Check one Box SL Tab 2mg sublingual film 2mg/0. 5mg SL Tab 2mg/0. 5mg Quantity Sig RATIONALE FOR PRIOR AUTHORIZATION Primary Diagnosis ICD-....

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  5. Enter the appropriate date and affix your electronic signature after completing all other fields.
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The payer ID specifically for Magellan claims is the same as the general payer ID for Magellan. This information is vital for accurate and efficient claims processing. When filling out the 14100 Magellan Plaza Form, make sure to include this payer ID to facilitate a smooth reimbursement process.

The payer ID for Magellan is essential for filing claims correctly. You can typically find this information on the Magellan website or through your provider portal. Ensure that you use the correct payer ID when submitting the 14100 Magellan Plaza Form to avoid delays in processing your claims.

To contact a Magellan provider, you can use the customer service number listed on their official website or on your insurance card. Additionally, Magellan has an online provider portal where you can find contact information for specific providers. For more streamlined communication, consider utilizing the resources available through the 14100 Magellan Plaza Form.

The timely filing limit for Magellan claims is typically 180 days from the date of service. It is crucial to submit your claims within this timeframe to ensure proper reimbursement. If you are unsure about the time limits, you can refer to the guidelines provided by Magellan or consult the 14100 Magellan Plaza Form for more details.

Under Magellan's policies and procedures, the standard timely filing limit is 60 days. For exceptions to timely filing requirements for specific states and plans, sign in to this website to view our timely filing exceptions.

Where is Magellan Rx Management's headquarters? Magellan Rx Management's headquarters is located at 4801 E Washington St, Phoenix.

Magellan is headquartered in Phoenix, Arizona, the US.

About Magellan Health : Headquartered in Scottsdale, Ariz. , Magellan Health, Inc . is a healthcare management company that focuses on fast-growing, complex and high-cost areas of healthcare, with an emphasis on special population management.

Magellan manages some components of Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc. (Kaiser Permanente) HMO, POS, PPO, and Medicare provider networks for outpatient mental health and substance use disorders services.

Centene, a dominant company in Medicaid managed care, acquired Magellan Health in January for $2.2 billion but has been selling off chunks of the parent company since. In addition to selling Magellan Rx to Prime Therapeutics, St.

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