Provider Resources

Claims/Check Eligibility/View Authorizations

Providers can check claims status, check member eligibility, view authorizations and do much more by signing in to the Magellan Provider Website with your secure username and password. 

Click here for best practices on submitting claims to Magellan.

Check Member Eligibility

Providers are responsible for verifying the members eligibility for HealthChoices coverage through the PA Medical Assistance (MA) PROMISe Eligibility Verification System:  

  • Prior to the first appointment,
  • Throughout the course of treatment, and
  • Prior to submitting claims

For information regarding the different options for checking EVS, click here to go to the DHS website or call # 1-800-766-5387 for interactive (real-time) eligibility verification (24/7).

When applicable, hard copies of the EVS printout are to be maintained in the member's medical record.

You may also check eligibility by calling Magellan's customer service department.

Providers should also be advised that the use of Magellan's tool for review of eligibility and benefits does not guarantee claims payment. Payment of benefits is subject to the member's eligibility on the date service is rendered and any other contractual provisions of the plan. Payment is also subject to pre-authorization guidelines.

 

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