Volume 1, Summer 2026

Hospital Connections

 

Observation Billing

Consistent with CMS guidance, observation services billed for less than 8 hours are not reimbursable.  Observation care must span a minimum of 8 hours and be documented in the patient’s medical records.  If the observation period is for less than 8 hours, claim payment will default to the Emergency Room rate if claim is accompanied by an ER claim line. 

Likewise, observation services billed for greater than 48 hours will constitute an inpatient admission and the claim will reimburse at the appropriate inpatient rate. Reminder, it is not appropriate to bill observation services for maternity patients seen outside of the Emergency Room.

Readmissions

MagnaCare may pend or deny a claim and request medical records or additional information if a claim meets any of the following conditions:  same day readmission for a related condition, planned readmission, or unplanned readmission with thirty (30) days after a previous discharge.

Please follow the denial or pend remark codes on ERAs for next steps to submit records and additional information.

No Surprises Act

The No Surprises Act (NSA) has significant implications for facility policies and procedures, particularly in the areas of billing, disclosure, notice, and consent practices. Here is a key point to remember:

• Good Faith Estimates:  Make sure that patients are made aware of any non-participating providers that will be participating in their care at the hospital and that they are entitled to a good faith estimate from those providers.  This disclosure should be made for all emergent and non emergent care at participating facilities.

Avoiding Long Call Hold Times

Did you know that the MagnaCare Provider Portal can provide claim detail information and as well as other important features such as Authorization Request Submission?

Physicians and Other Professional Providers

 

E&M Codes Billed at the Same Time as Psychotherapy

Only Physicians can bill Evaluation and Management codes.  Therapists should use CPT codes 90832-90838 only.  Psychotherapy without medical evaluation and management services are reported as 90832, 90834, and 90837.  Psychotherapy with medical evaluation and management services are reported with codes for E/M services plus a psychotherapy add-on code (90833,90836, 90838).

MagnaCare’s Credentialing Process

All individual providers seeking participation in our provider network must go through the credentialing process. The following are the minimum requirements for individual provider participation qualification:

• Application and attestation, Magnacare/MagnaCare Casualty/Create® or current, attested CAQH profile
• Signed contract
• Current and valid license to practice
• Appropriate training, including board certification
• Current malpractice insurance with minimum limits of $1,000,000/3,000,000
• DEA (if prescribing controlled substances)
• Acceptable malpractice and sanction history
• To request an application for individual participation, email [email protected].
• All application submissions must include a W-9 form.

Electronic Fund Transfer (EFT) and Electronic Remittance Advice (ERA)

How to Enroll your office:  Providers can register and log into MagnaCare.com to enroll for EFT/ERA.  You will need to include a voided check from your bank account in which you wish to deposit electronic payments.  You can submit these documents to MagnaCare Provider Services in one of these ways:

• Via Fax:  (516) 723-7397
• Via Email:  [email protected]
• Via the MagnaCare Provider Portal

Basic Requirements: 

• A bank account in which to deposit the electronic funds.
• Your clearinghouse/software vendor must be able to accept the ERA file in the 835 HIPAA standard format.

Rules for EFT/ERA:

• MagnaCare will issue EFT and ERA for claims that are administered by MagnaCare.
• EFT and ERA are supported at the TIN (Tax Identification Level).
• All providers billing under the practice TIN will be enrolled in the EFT/ERA process.

MagnaCare Claims Submissions

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

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

Click here to see a MagnaCare ID card with explanations.