Policyholders

Important things to know:

Pre-certification requirements:

Pre-certification review is required for: (a) Hospital confinement (b) Skilled Nursing Care Facility Confinement; (c) Home Health Care; (d) cardiac/pulmonary rehabilitation; (e) hospice care; (f) infusion therapy; (g) durable medical equipment; (h) prosthetic devices; (i) organ and tissue transplants; and if applicable, (j) maternity care.

Benefits will be reduced or eliminated for failure to meet any applicable pre-certification requirements (see the "Rules for Pre-Certification Review" and “effect on benefits” sections in your policy certificate.)

Case Management

Your NHHP Policy includes benefits for case management services. If you incur expenses as a result of and injury or sickness listed in your policy certificate under Case Management Procedures or as a result of any injury or sickness of comparable severity for which an alternate, more cost effective treatment plan may be developed by us, these case management expenses may be paid by NHHP.

Grievance Procedures

You have the right to appeal any adverse decision through our appeals process. Click Appeals Process Notice to appeal.

Grace Period

Your premium must be paid on or before the date it is due or during the 31-day grace period that follows. Claims will not be paid unless and until the due premium has been paid.
(to view all policy forms go to our "downloads" page)

How to File a Medical Claim

Any bill submitted to BMI should contain the following information:

Name of Insured
Insured's Social Security Number
Name of Patient
Date(s) of Service
CPT (Current Procedural Terminology) Code
ICD-9 Code (Diagnosis)
Amount charged
In case of an accident:
In addition to the above, please include:
- Date
- Time
- Place
- How the accident happened
Also, please note if it is work related.

Please submit claims to:
First Health
P.O. Box 8530
Kansas City, MO 64114

WebMD EDI# 01066

Please note, you only need to follow these procedures if your provider doesn't bill BMI directly.

If you have any questions on a claim filed, please contact Customer Service at 877-888-NHHP (6447).

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How to File a Claim