Magellan Health

For Providers

NOA Forms

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.

If you have questions, please e-mail

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Are You in Crisis?

If you are in crisis, call the Crisis Line at (800) 631-1314, TTY (800) 327-9254. For emergencies, always call 9-1-1


Everyone has the right to have personal information kept private. We work hard to protect your privacy. Read more.

Contact Information

Mercy Maricopa Integrated Care (Mercy Maricopa) is now the Regional Behavioral Health Authority (RBHA) serving members in the Maricopa County Region. For questions regarding your services, please call 1-800-564-5465 or TDD/TTY 711.

** To file a grievance or appeal for services provided on or before March 31, 2014 please call Magellan Health Services 602-652-5907, x8590