Provider Responsibilities

Availability and Access to Care

Providers must ensure availability of health care services by a BHN participating provider twenty four (24) hours per day, seven (7) days per week, three hundred and sixty five (365) days per year including coverage for weekends, vacations and after office hours.

Referrals

BHN requires participating providers to use reasonable efforts to find in-network providers for our members. This includes surgical assistants or assistant surgeons.

MagnaCare in-network providers can be found here.

Create in-network providers can be found here.

Referrals to an emergency room should not occur for care that can be provided in an office setting.

Checking Eligibility

Providers should verify each patient’s eligibility and benefits prior to rendering services. Verification requests shall be confirmed directly with BHN, unless otherwise indicated.

When a member presents with an emergency condition, eligibility verification must occur within two (2) business days of initial treatment if the individual is admitted to the hospital. The hospital shall notify BHN or payor’s utilization department, as applicable, upon admission of any member within the standard requirement established by BHN or such payor, as applicable.

For a MagnaCare member, log into a provider’s account here.
Use the Member ID to search for member eligibility or call Provider Services at 800-352-6465.

For a Create member, log into a provider’s account here and navigate to ELIGIBILITY & BENEFITS. Use the Member ID to search for member eligibility or call our Provider Services team at 1-844-427-3878

Up-to-Date Information

Providers are responsible for ensuring BHN has a provider’s most current information on file. This information includes name, address, phone number, billing information and provider status.

Please review information as reflected on MagnaCare’s website and make sure to submit any changes to [email protected] or within the provider portal.

Review information as reflected on Create’s website and make sure to submit any changes to [email protected].

Provision of Covered Services

Provider may only provide covered services:

• As ordinarily and customarily provided by a healthcare provider similar to provider.
• Within the scope of the provider’s operating certificate or other applicable license or certificate.
• Consistent with these Administrative Guidelines and standard prevailing in the community.
• In accordance with all applicable laws, rules and regulations.

Utilization of Participating Providers

Provider shall make best efforts to use participating providers to coordinate delivery and site of service for covered services to a member. If provider does not have appropriate admitting privileges with participating hospitals or access to other participating providers, provider will appropriately coordinate through BHN to identify other healthcare providers or locations to perform such Covered Services.

Non-discrimination

A provider shall furnish covered services to BHN members in the same manner in which a provider provides services to all other patients. With the same availability, and shall not discriminate in the treatment of patients on the basis of race, sex, age, religion, place of residence, HIV status, sexual orientation, creed, color, national origin, source of payment (including Covered Persons status as a member of a Plan), type of illness or condition, or disability or other basis protected by state or federal law.