Claims Process

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Submitting a Claim

Submit claims through BHN’s clearinghouse Change HealthCare. The MagnaCare Payor ID is 11303 and the Create Payor ID is CREA8.

Payor ID, though, may diverge based on a member’s specific plan. The correct Payor ID is usually found on a member’s card, but a phone call or further research may be necessary in certain circumstances; using the correct Payor ID is essential to receiving timely, proper reimbursement.

Mail paper claims to:

MagnaCare products:
MagnaCare P.O. Box 1001
Garden City, NY
11530

Create products:
Create
P.O. Box 8116
Garden City, NY
11530

Claim Requirements for All Claims

  • Patient name
  • Patient address
  • Patient gender
  • Patient date of birth
  • Patient policy number
  • Patient relationship to subscriber (policy owner)
  • Subscriber name (if different from patient)
  • Subscriber address (if different from patient)
  • Subscriber policy number (if different from patient)
  • Rendering provider’s name
  • Rendering provider’s signature (or authorized representative’s)
  • NPI
  • TIN
  • Address where services were rendered
  • Remit to address
  • Phone number
  • Date of service
  • Place of service
  • Number of services included days/units rendered
  • CPT code(s)
  • HCPCS procedure codes with modifiers where appropriate
  • Current ICD-10-CM diagnostic coded by specific service code to the highest level of specificity
  • Charge per service and total charges
  • Detailed information about other insurance coverage (if relevant)

Additional Claim Requirements for UB-04

  • Date and hour of admission
  • Date and hour of discharge
  • Member status at discharge code
  • Type of bill code
  • Type of admission
  • Current 4-digit revenue code
  • Attending physician ID
  • For outpatient services, the specific CPT or HCPCS codes, line item date of service and appropriate revenue code(s)
  • Completed box 45 for physical, occupational or speech therapy services (rev codes: 0420-0449)
  • Any special billing instructions contained in provider’s Brighton agreement
  • On an inpatient hospital bill type of 11x, use the actual time the member was admitted to inpatient status
  • If charges are rolled to the first surgery revenue code line on hospital outpatient surgery claims, report a nominal monetary amount on all other surgical revenue code lines to ensure appropriate adjudication
  • Include the condition code designated by the national uniform billing committee (NUBC) on claims for outpatient preadmission non-diagnostic services that occur within three calendar days of an inpatient admission and are not related to the admission

Unlisted Codes

Submission of unlisted medical or surgical codes should include a detailed description of the procedure or service.

Claim Edits

When claims are submitted using EDI, HIPAA edits are applied to help ensure claims contain specific information. Any claims not meeting BHN requirements are rejected and returned back to the provider for corrections.

BHN utilizes industry standard claim editing software to ensure appropriate and standardized claim processing and has the right to re-bundle services that are included in the primary procedure.

BHN’s General Review of Claims

BHN has the right to review claims to confirm a provider is following appropriate and nationally accepted coding practices. BHN may adjust payment to the provider at a revised allowable amount if accepted practices are not being followed. Providers must cooperate by providing access to requested claims information, all supporting documentation and other related data.

BHN may pend or deny a claim and request medical records to determine whether the service rendered is covered and eligible for payment. BHN will send notification regarding what is needed. To help claim processing and avoid delays due to pended claims, please resubmit only what is required. Returning a copy of the notification with your additional documents is necessary for proper resubmission.

Checking the Status of a Claim

To check the status of a claim, log into the provider’s account:

MagnaCare products

Create products

Claims are searchable using Member ID, Patient Account Number, Claim ID and other criteria.

Claim status can also be requested by performing an ANSI 276 transaction through Change Healthcare.

For more information, contact Provider Services:

MagnaCare products: 800-352-6465 or email [email protected]

Create products: 844-427-3878 or email [email protected]

Claim Correction and Resubmission Standards

When correcting or submitting late charges on electronic 837 institutional claims, use bill type xx7, replacement of prior claim. If resubmitting via paper, submit a new bill indicating the correction made and mail it to the address on the EOB from the original claim.