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Magellan Health

Quarterly Data Validation

In support of NCQA, federal, and CMS regulations and standards, Magellan requires participating providers to sign into our online Provider Data Change Form each calendar quarter to validate the accuracy of their practice information.

Federal mandate requires your attention to practice data

The Consolidated Appropriations Act of 2021 (“CAA,” which contains the “No Surprises” rules at 42 USC 300gg-115) became effective Jan. 1, 2022. The rules seek to protect members from excessive out-of-pocket costs (surprise billing), improve access to care, and help ensure that information available to members in provider directories is updated and accurate.

The legislation is designed to serve the interests of members enrolled in commercial and employer health plans, and group or individual health insurance coverage. Thus, as a Magellan in-network provider serving this substantial population, your participation in this federally mandated process is critical.

What happens next

To comply with the CAA legislation, we are required to verify and update our provider directory information for commercial and employer plan members quarterly.* What happens to your practice information, as it appears in the provider directory, during this review, will depend on how often you validate your information:

  • When you validate your practice information each quarter (as required by policy for contracted providers), your information will continue to appear in the commercial and employer plan directories.
  • If you do not validate your practice information by the dates required, your information will not display in our electronic or paper directories for use by commercial and employer plan members.
  • If you miss validating your practice information for a given quarter and later go back to do so, your validated practice information will again appear in our provider directories within two business days of receipt of your validation.

Not updating your information will restrict the ease with which members can contact and self-refer to you, so please work with us to regularly maintain and attest to your practice/organization information.

We appreciate your compliance and collaboration on this federally mandated initiative.

More information

Find our policies related to updating practice information in the Magellan National Provider Handbook (PDF), Section 2: Updating Practice Information, and for organizational providers in the Organizational and Facility Provider Handbook SupplementSection 2: Communication.

*If you serve in one of the public sector programs that Magellan manages, such as District of Columbia Medicaid, Louisiana Coordinated System of Care, Pennsylvania HealthChoices, Virginia Medicaid and Wyoming Care Management Entity, please note that the data validation requirements will differ. Your provider directory information for these enrollees is not impacted by this legislation. The same is true for employee assistance programs, commercial Medicare and Medicaid plans.