This page provides you with the forms you will need to complete a Notice of Action.
Providers should note that this is the Notice of Action form that Magellan uses to send out its own NOAs. When the NOA form is issued by a provider, the Magellan logo and customer service phone information should be changed to reflect the provider's information. If you have any questions, or if you would like to download a version of the "writable" NOA please click on the version you need.
- Notice of Extension
- PM Form 5.1.1 NOA letter, English (8-07-13)
- PM Form 5.1.1 NOA letter, Spanish (8-07-13)
- 5.3.1 English
- 5.3.1 Spanish
- Legal Services Attachment
If you have questions, please e-mail MaricopaNOA@MagellanHealth.com.