Appealing Credentialing Decisions
Providers have the right to appeal credentialing determinations with which they disagree.
Client requirements and applicable federal and state laws may impact the appeals process; therefore, the process for appealing credentialing determinations is outlined in the credentialing notification letter.
To comply with this policy, your responsibility is to:
- Follow the instructions outlined in the ineligibility letter if you wish to appeal an ineligibility determination
Magellan's responsibility is to:
- Notify you in a timely manner of the determination that you do not meet Magellan’s credentialing criteria and therefore will not be included in the provider network
- Consider any appeals submitted in accordance with the instructions outlined in the ineligibility notification letter, subject to applicable state law