Authorizations and claims

Medical necessity criteria

Magellan is committed to the philosophy of providing treatment at the most appropriate, least restrictive level of care necessary to provide safe and effective treatment while meeting the individual patient’s biopsychosocial needs.

Find information about medical necessity criteria in Section 3 of the Provider Handbook Supplement for Connect Nevada: Strengthening Youth, Empowering Families.

Viewing authorizations

You can view your authorizations from the Magellan of Nevada Payer Space in Availity Essentials.

  • If you’re already using Availity Essentials with another payer, you’re set to work with Magellan of Nevada on Availity Essentials.
  • If you don’t already use Availity Essentials, set up your account now. (There is no cost for registration or use.) Availity has complimentary webinars and resources to help you get started with your registration. How to get started with Availity.

Electronic funds transfer (EFT) sign-up

With EFT, payments are securely deposited directly into your bank account. Magellan network providers must enroll in EFT. EFT is available to providers who own the Taxpayer Identification Number (TIN) linked to the submitted claim. ECHO Health processes the payment of Magellan claims.

There are two options for EFT sign-up:

Option 1 - No fees

Enrollment for Magellan claims payment only (no fees apply),

Visit: https://enrollments.echohealthinc.com/efteradirect/Magellan.

NOTE: You must await your initial payment via virtual credit card before you can register for EFT.

Required for first-time enrollment:

  • Draft number
  • Draft amount (supplied with your initial payment)
  • TIN

Where to find draft number/amount on your EOP.

Option 2 - Fees apply

Enrollment to receive EFT from all payers that process payments on ECHO’s platform (fees apply)

Visit: https://enrollments.echohealthinc.com.

NOTE: Fees also apply when signing up via echovcards.com.

View these frequently asked questions about ECHO payment options.

Using EFT

Once you begin to receive EFT payments from ECHO, you will not receive Explanation of Payment (EOP) or Explanation of Benefits (EOB) by U.S. mail. You can access and print EOP and EOB information through ECHO’s provider portal

If you have not yet registered for the ECHO Provider Payments Portal register now.

NOTE: ECHO EFT enrollment is separate from ECHO provider portal registration.

  • Draft number, draft amount (supplied with your payment from ECHO) and your TIN are required for first-time registration.
  • To obtain the processing result for EFT-paid claims, you can use the Inquiry page .
  • If a claim is denied, no payment is due and there will be no EFT transaction. Non-payment transaction documents are also posted.

EFT/ERA assistance

Contact ECHO Health at 1-888-834-3511 or email edi@echohealthinc.com for:

  • EFT/ERA enrollment questions (status of enrollment).
  • EDI questions (835 clearinghouse delivery, how to access or use the provider payments portal to download 835s).
  • Changes to your bank account.

Resolution process for late or missing EFT and electronic remittance advice (ERA)

Submitting claims

Magellan of Nevada is committed to reimbursing our providers promptly and accurately in accordance with our contractual agreements. We encourage providers to submit claims electronically using one of the following methods:

Option 1 - Individual claims

You can submit individual claims to Magellan of Nevada using Availity Essentials.

  • If you’re already using Availity Essentials with another payer, you’re set to work with Magellan on Availity Essentials.
  • If you don’t already use Availity Essentials, set up your account now. (There is no cost for registration or use.) Availity has complimentary webinars and resources to help you get started with your registration. How to get started with Availity.
Option 2 - EDI claims

HIPAA-compliant 837 files can be sent directly to Magellan in bulk, without accompanying claim data entry or the involvement of a clearinghouse. Direct Connect is available to all providers regardless of claims submission volume. There is no charge to you for using the service. You can register to submit EDI claims to Magellan by sending an email to EDISupport@MagellanHealth.com.

Option 3 - Clearinghouses

External EDI clearinghouses act as a middleman between the provider and Magellan, and can transform non-HIPAA-compliant formats to compliant 837s. Magellan accepts 837 transactions from a number of clearinghouses.

NOTE: There may be charges from the clearinghouses.

More information

Find Magellan of Nevada policies for accurate and timely claim submission in Section 5 of the Provider Handbook Supplement for Connect Nevada: Strengthening Youth, Empowering Families.