How to File a Claim
In order to process a medical claim under an accident insurance program, BMI Benefits will need the following documents
- Fully Completed and Signed Accident Claim Form
- Itemized Medical and Dental Bills
- Primary Insurance Explanation of Benefits (EOB) where applicable
These documents can be mailed, faxed, emailed directly to BMI, or uploaded through BMI’s secure FTP link. Accident claim forms should be submitted within 90 days from the date of accident and bills should be submitted within 1 year from the date of service to avoid any denial due to timely filing.
BMI Benefits, LLC.
P.O. Box 511
Matawan, NJ 07747
Learn More About the Documents
o Physician’s Billing – HICFA 1500 Form (hyperlink to sample form)
o Hospital/Facility Billing – UB04 Form (hyperlink to sample form)
o Dental Billing – ADA Dental Claim Form (hyperlink to sample form)
Please contact the medical providers and request the above documents. You can also ask the medical provider to bill BMI directly. To do this, you will need to tell them you have secondary insurance through BMI Benefits and provide our billing information.