2022 Downloadable Resources
Download or share these onboarding resources with your practice staff:
Find everything you need in order to see Bright HealthCare members.
Updated November 15, 2022
As outlined previously, Bright HealthCare has identified an error in the administration of the In-Office Laboratory Testing payment policy. This is improperly causing the blood draw codes, including CPT 36415, and certain laboratory test codes in the 80000 series to be denied incorrectly when billed with the office place of service (POS 11).
Reprocessing of claims is currently underway.
In the meantime, there is no need to submit a claim appeal or provider dispute, as we will correct the affected claims and claim lines.
We apologize for the inconvenience and thank you for your patience. If you have any questions in the interim, please contact:
IFP Legacy States:
AL, AZ, CO, FL, IL, NC, NE, OK, SC, TN
866-239-7191
Small Group:
855-521-9364
Use our Member Lookup Tool for Individual & Family plan members.
For Medicare Advantage plan members call 844-926-4522.
Helping your Bright HealthCare patients stay in-network is easy! Find in-network care for your patients.
Download or share these onboarding resources with your practice staff:
2022 Quick Reference Guide
2022 Pharmacy Updates
New pharmacy benefits manager, new specialty pharmacy, electronic prior authorization and more
Learn how to set up payment accounts and how to submit, track and manage claims.
Provider dispute resolution: For issues that do not involve routine inquiries resolved in a timely fashion through informal processes, we offer a provider dispute process for administrative, payment, or other disputes that you may have. Dispute categories include:
By using our provider disputes form, you avoid delays and receive an acknowledgement with a case number. For more information regarding federal and state mandated arbitration and mediation please see here.
Please refer to your provider manual or contact Provider Services with any questions.
Find more information on Bright HealthCare's clinical programs, including prior authorizations and how to refer your patients for case management.
After contracting with Bright HealthCare, completion of the Provider Roster Template is the next step in adding your providers to the Bright HealthCare network.
Any changes to your practice (providers or service locations) should be submitted on the standard roster template, when appropriate. Below is a pdf with instructions and links to the appropriate roster templates for your region. Please review the Provider Resource Guide located on Availity for more information.
CMS requires providers who serve Bright Health Special Needs Plan (SNP) members to complete annual training on the SNP Model of Care (MOC). The MOC describes how Bright Health identifies and addresses the unique needs of its SNP members. Annual MOC training ensures providers are educated about and able to leverage the services and supports available to SNP members. Please click below to complete the SNP MOC training and attestation.
Claims news! Bright Health is making life easier by changing from multiple payer IDs to one payer ID when you file a claim!
Effective 1/1 please use Payer ID BRGHT for all submissions
In order to avoid rejected claims, please ensure you share this information with your IT department to update EDI, clearinghouse and other software processes.
Important: Updates regarding Bright HealthCare electronic benefits query and Payer ID for Emdeon
Access program information for your patients to lower disease burden measures.
In-Office Laboratory Testing Payment Policy (Effective 10/1/2021)
Change Healthcare Coding Advisor Program
To learn more about this program, please review this FAQ
To search additional policies, please visit Availity.
Individual and Family Plans
(CA, GA, TX, UT, VA):
844-926-4525
(AL, AZ, CO, FL, IL, NC, NE, OK, SC, TN):
866-239-7191
Medicare Advantage Plans
(AZ, CO, FL, IL, NY):
844-926-4522