Magellan and Carelon credentialing: joining the company that runs the behavioral health network

Part of our credentialing guide for Texas practices and programs. Other plans: Wellpoint Texas · Cigna / Evernorth · UnitedHealthcare / Optum · Humana.

What a behavioral health manager is

Many health plans and employers hand their mental health and substance use benefit to a separate company. That company builds the behavioral health network, credentials and contracts the providers, reviews authorizations and, often, pays the claims. The plan's name is on the card; the manager's rules govern your work. Carelon, for example, posts provider orientation materials for Humana's Medicaid and dual-eligible plans in Illinois and Florida (example), and Magellan runs an employee assistance program (EAP) network for employers.

What that means for credentialing: being in network with the health plan doesn't make you in network for its behavioral health benefit if a manager runs it, and the reverse is true too. Applying to the medical plan when the manager runs the network wastes weeks.

Do you need Magellan or Carelon?

Only if your clients' plans use them. Check before you spend time on either application:

1. Read the back of the card. A separate "behavioral health" or "mental health and substance use" phone number, or a Carelon or Magellan logo, is the tell.
2. Read the eligibility response. A 271 response often names a different payer or phone number for mental health benefits. Our sister product's guides to behavioral health carve-outs and how to read an eligibility response show where to look.
3. Ask the plan. Call provider services and ask, "Who manages behavioral health for this product, and who credentials outpatient therapists and IOPs?" Write down the answer and the reference number.
4. Count the clients. Look at your last 6–12 months of inquiries. If a manager handles a meaningful share, it belongs on your credentialing list; if not, put your effort into the plans that do.

Carelon and Magellan side by side

Carelon in Texas

• Wellpoint. Carelon's Texas documents describe it as an independent company providing behavioral health management on behalf of Wellpoint, and Carelon publishes a Texas quick reference guide for Medicare and Medicaid with a dedicated Medicare service line, plus a December 2024 provider handbook addendum for Wellpoint Texas. Wellpoint (formerly Amerigroup) is one of the Texas Medicaid health plans, and the guide's Medicare line shows Carelon handles Wellpoint Medicare members too.
• Parkland ended. Carelon's Texas forms page says Carelon stopped managing the behavioral health benefit for Parkland Community Health Plan effective September 1, 2025.
• Which door for Wellpoint? Before you apply, ask Wellpoint's provider services whether your behavioral health contract for the products you want (STAR, STAR+PLUS, CHIP or Medicare) runs through Wellpoint's letter of interest or through Carelon. Our Wellpoint Texas guide covers Wellpoint's own routes; for Medicaid you'll also need TMHP enrollment first (see Texas Medicaid credentialing).

We couldn't confirm from Magellan's public pages which Texas health plans, if any, use Magellan to manage behavioral health in 2026. Its EAP network is a separate door: if you join it, a Texas client may reach you through their employer's Magellan EAP.

Joining Carelon, step by step

Carelon's Join Our Provider Network page sets the route:

1. Register in Availity. You must be registered before you can enroll; all new enrollment requests go through the Carelon Behavioral Health payer space.
2. Individuals and group clinicians: finish and attest CAQH ProView and authorize Carelon, because the Availity tool pulls your data from it. Our CAQH ProView guide covers each section. Carry malpractice coverage of at least $1 million per episode and $3 million aggregate, the minimum on Carelon's practitioner credentialing application.
3. Start a new application in the Enrollment section, choosing your provider type: individual, group, joining a group, or facility.
4. Facilities: choose Facility, upload the required documents in Availity (not by email), and be currently accepting new patients, which Carelon requires to apply.
5. Track the status in Availity. Carelon decides which networks you qualify for; once eligibility is confirmed, a contract associate contacts you. Submitting doesn't guarantee inclusion, and incomplete or incorrect forms delay or block processing.
6. Read the contract for the plans and products it covers, the rate for each code, timely filing, and the effective date, then sign.

Joining Magellan, step by step

1. Request network consideration. On MagellanProvider.com, go to Provider Network, then Join the Network. A solo clinician chooses the individual option and follows the network screening instructions. A group or facility contacts its Network Contact for an application.
2. Get CAQH ready. Magellan's guidance: keep the profile current, authorize Magellan, explain any work-history gap of six months or more in the last five years in writing, and upload a current malpractice face sheet.
3. Meet the selection criteria for your license; Magellan publishes professional provider selection criteria.
4. Credentialing review. Magellan's credentialing process checks that every section and document is in, verifies items such as license status, malpractice coverage and education, then sends qualifying files to its Regional Network and Credentialing Committee.
5. Contract. Credentialing approval and contracting are separate steps; Magellan's credentialing vs contracting explainer says you're in network only once a contract is executed.
6. If you're declined, Magellan sends a letter with the reason and the steps to contest it.

Magellan also recruits for its EAP network. EAP sessions are short, prepaid by the employer and have their own forms; decide whether that fits your practice before you join.

IOP and PHP programs

A licensed program joins each manager as an organization. What to expect:

• Accreditation or a site visit. Magellan's Organizational and Facility Provider Handbook Supplement (revised November 2025) expects accreditation by an accepted body and offers a Magellan site visit for a facility that isn't accredited, which can lengthen the process. Carelon's provider handbook lists the accreditors it accepts; its older state manuals describe a site visit for unaccredited facilities. A new Texas program should plan the survey early (see accreditation for new programs).
• A clean license. Magellan wants current licensure without contingencies and no Medicare or Medicaid sanctions or exclusions; Carelon wants a current, unencumbered state license. Your HHSC license must list every level of care you're asking to contract (see the Texas chemical dependency treatment facility license).
• Liability coverage: Magellan's facility minimum is $1 million per occurrence and $3 million aggregate. Ask Carelon for its current facility minimum.
• Staff. Carelon's handbook says once a facility is credentialed and contracted, its licensed or certified behavioral health professionals may treat members for the applicable services, and the facility is responsible for credentialing and overseeing them. That makes your own staff credential files part of the deal; our staff credential file checklist covers what to keep.
• Operational attestations. Carelon's facility initial credentialing application asks you to attest to things like after-hours contact, a grievance procedure, accessibility and routine appointments within 10 calendar days, and asks unaccredited facilities about malpractice suits.
• New services need notice. Carelon's handbook asks for 60 days' advance notice of any new program or service. Adding PHP to an IOP? Tell Carelon before you bill it (see adding a level of care).

Have the packet in one folder: Type 2 NPI, W-9, license, accreditation letter and latest survey, liability certificates, medical director's license, and a program description by level of care with the codes you bill. Our guide to insurance contracts for treatment centers covers the per diem and authorization terms to check before you sign.

Magellan's ownership change

Centene, which bought Magellan Health in January 2022, agreed in December 2025 to sell its remaining Magellan businesses to Madison Health Group, subject to closing conditions and regulatory approvals (Behavioral Health Business, February 2026). We couldn't confirm whether the sale had closed by October 24, 2026. For providers, a change of owner usually means new contract notices, possibly new portals and payer IDs; read every notice from Magellan and keep your contract and rate exhibit where you can find them.

Recredentialing and upkeep

• Carelon: recredentialing every three years, or the period state law or regulation requires, per its handbook.
• Magellan: credentials reviewed about every three years as a condition of continued participation (Magellan's recredentialing process).
• CAQH every 120 days for both, and current malpractice certificates uploaded before the old ones expire.
• Facilities: keep license, accreditation and liability certificates current with each manager, and report new services and locations before you bill under them.

Credentialing upkeep, $49 per clinician a month, covers CAQH re-attestation, renewals, recredentialing and roster changes for every plan and manager.

How we work these files

You can see the statuses in the client portal tour, with a made-up practice.

Why these files stall

1. Applying to the wrong company: the health plan when the manager credentials, or the manager for a product it doesn't manage.
2. Emailing a Carelon facility application, or applying before registering in Availity.
3. CAQH not authorized for the manager, or not attested.
4. An unexplained work-history gap of six months or more.
5. A facility without accreditation that isn't ready for a site visit, or a license with conditions.
6. Malpractice limits below $1 million / $3 million.
7. Billing a new level of care before the manager has been told and has added it.

What we do, and what it costs

Cima Consulting checks which manager your clients' plans actually use, then files Carelon and Magellan the way this page describes, with follow-up every two weeks and a contract check before you sign. You sign every application and contract yourself.

A clinician with Carelon or Magellan is $175 per plan each; a program's facility contract is $450 per plan. Opening a program? The IOP / PHP Program Launch includes facility contracts with your first plans and managers.

Questions

Back to credentialing for Texas practices and programs, or read the Wellpoint Texas guide.

Sources

All checked October 24, 2026. Carelon and Magellan revise these pages and forms; open the current version before you rely on any detail.

1. Carelon Behavioral Health, Join Our Provider Network. carelonbehavioralhealth.com
2. Carelon Behavioral Health, Provider Handbook. carelonbehavioralhealth.com
3. Carelon Behavioral Health, Practitioner Credentialing Application. carelonbehavioralhealth.com
4. Carelon Behavioral Health, Facility Initial Credentialing Application. carelonbehavioralhealth.com
5. Carelon Behavioral Health, Texas quick reference guide (Medicare and Medicaid). carelonbehavioralhealth.com
6. Carelon Behavioral Health, Texas forms and guides. carelonbehavioralhealth.com
7. Carelon Behavioral Health, Provider orientation and training for Humana Healthy Horizons in Florida (2024). carelonbehavioralhealth.com
8. Magellan, Join the Network. magellanprovider.com
9. Magellan, Credentialing Process. magellanprovider.com
10. Magellan, What You Need to Know About Credentialing and Contracting. magellanprovider.com
11. Magellan, Professional Provider Selection Criteria. magellanprovider.com
12. Magellan, Organizational and Facility Provider Handbook Supplement (rev. 11/2025). magellanprovider.com
13. Magellan, Recredentialing Process. magellanprovider.com
14. Magellan, Join Magellan's EAP network. magellanprovider.com
15. Behavioral Health Business, Magellan Health to become independent again under Madison Health Group deal (February 17, 2026). bhbusiness.com

General information, not legal advice. Cima Consulting isn't a law firm and isn't affiliated with Carelon, Magellan or any plan they serve; each makes its own network decisions, and we don't guarantee a contract, rate or date.