NOA Forms
This page provides you with the forms you will need to complete a Notice of Action.
Forms
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.
- PM Form 5.1.1 NOA letter, English (1-13-12)
- PM Form 5.1.1 NOA letter, Spanish (1-13-12)
- 5.3.1 English
- 5.3.1 Spanish
- 5.1.2 English
- 5.1.2 Spanish
- Legal Services Attachment (pages 313 to 314 of the AHCCCS ACOM)
If you have questions, please e-mail MaricopaNOA@MagellanHealth.com.
If you have any questions about your services, please call Magellan at (800) 564-5465, TTY (800) 424-9831. If you are in crisis, call the Maricopa Crisis Line at (800) 631-1314, TTY (800) 327-9254. For emergencies, please always dial 911.
This page last updated: Friday, January 27, 2012.