Claims Submission Requirements

Claim Status

After submitting a claim, Providers can check status on the Brand New Day Provider Portal. If you are a Registered Provider, visit the Provider page. If you are not a registered Provider, complete the registration form to request access and create your own personal login and password.

You or your billing agent can obtain real-time results by checking claim status through the Medecision Claim Research Tool. The Claim Research Tool provides the equivalent of an Explanation of Benefits (EOB), including line item breakdown. If you have any questions or need assistance contact our Claims Inquiry Department at (866) 255-4795 and a Claims Inquiry Representative will assist you.

Non-Contracted Provider Fee Schedule for Medicare and Medi-Cal Members

The Professional Fee Schedule applies to professional services only. The fees in this schedule are not applicable to facility related charges. Brand New Day pays the lessor of the provider’s billed charges, contracted rates, or Medicare / Medi-Cal allowable rates. Brand New Day’s objective in developing physician and healthcare professional compensation rates is to closely align payments with the resources used by providers for rendering professional services. Therefore, allowances may vary by geographic region.

Claim Submission: Electronic Claims

Electronic Claims are claims submitted electronically through a Plan-approved electronic billing system software vendor or clearing-house. Completion of electronic claim submission requirements can speed claim processing and prevent delays. Brand New Day accepts Professional and Institutional claims (ANSI 837P and 837I transactions).

To learn more about EDI, or for vendor options and information refer to Office Ally or contact support at (360) 975-7000 Option 2.

Providers must work with their vendors to ensure files are successfully submitted to Brand New Day. Failure of a third party to submit a claim to us may risk the Providers claim being denied for untimely filing if those claims are not successfully submitted during the filing limit.

Contact our Brand New Day Claims Department at (866) 255-4795 or email us at claimsinquiry@universalcare.com.

Claim Submission: Paper Claims

Paper claims are scanned for optimal processing and recording of data provided; therefore, even paper claims must be legible and provided in the appropriate format to ensure scanning capabilities. The following paper claim submission requirements can speed claim processing and prevent delays:

• Use the appropriate form type for submission
• Use black or blue ink; do not use red ink, as the scanner may not be able to read it
• Use the Remarks field for messages
• Do not stamp or write over boxes on the claim form
• Send the original claim form to us and retain the copy for your records
• Separate each individual claim form. Do not staple original claims together, as we would consider the second claim an attachment and not an original claim to be processed separately
• Information is typed within the designated area of the field. Be sure the type falls completely within the text space and is properly aligned with corresponding information. If using a dot matrix printer, do not use draft mode since the characters generally do not have enough distinction and clarity for the optical character reader to accurately determine the contents

Provider Dispute Resolution