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Click ‘Get Form’ to open it in the editor.
Begin with Part 1: Policyholder & Insured. Fill in the school/organization name, policy number, and student details including last name, first name, and social security number.
Complete the mailing address section and provide the city, state, zip code, birthdate, gender, phone number, date and time of injury, and location of the injury.
Indicate how the injury occurred and specify if it was during a supervised activity. Include details about the sport designation and type of sport.
In Part 2: Parent or Guardian Statement, enter both parents' names and contact information along with their employers' details.
Confirm if the student has other insurance coverage and provide the insurance carrier's name if applicable.
In Part 3: Authorization, read through the authorization statement carefully. Sign and date where indicated to authorize information disclosure for claim processing.
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NAHGA, which stands for National Accident Health General Agency, is a nationally-recognized TPA, or Third Party Administrator, with a focus on secondary accident insurance claims processing for clients across the country.
What type of insurance is BMC HealthNet?
For providers using other options, their vendors/routes will need to ensure they have a connection to Optums clearinghouse to submit claims to NAHGAs Payer ID 67788.
What is the phone number for Nahga eligibility?
What if the answer to my question is not here? Please contact us at: customerservice@nahgaclaims.com or call us directly at 800-952-4320 (M-F 8am 4:30pm EST).
What kind of insurance is National General?
BMC HealthNet Plan (BMCHP) is well positioned to support the State of New Hampshire in successfully transitioning to a Medicaid managed care environment. We are a not for profit HMO, founded by Boston Medical Center in 1997, when Massachusetts implemented a managed care program for Medicaid.
Change Health Care Commercial Par Payer Listing: 8/9/2017
Services to request claims setup at (787) 620-1414. Claims will reject if provider is not 4 enrolled. A 4A 4A Trans Par Trans Par COMMERCIAL M COMMERCIAL M
NAHGA Claim Services. P.O. Box 189. Bridgton, Maine 04009-0189. (800) 952-4320. (207) 647-4569 Fax. If this form is not completed in FULL, this claim cannot be
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