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Adverse Outcome Reporting

Providers for all levels of care have the responsibility to notify Magellan of member adverse outcomes. Please utilize the electronic form below.

Member’s Name *

Member’s Medicaid Number *

Facility / Provider Name *

Provider MIS Number *

Date of the incident *

Incident Type *

Provider contact name *

Provider contact number *

Detailed description of the incident (including the location, status of the member, steps taken to ensure continued member safety, and entities or other people notified) *

News & Publications

Adverse Outcome Reporting

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