Bright HealthCare Provider Resources

Find everything you need in order to see Bright HealthCare members.

Notice Regarding Bright HealthCare In-Office Lab Testing Payment Policy

Updated September 28, 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 expected to begin in November.

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

Need to look up a member ID?

Use our Member Lookup Tool for Individual & Family plan members.

For Medicare Advantage plan members call 844-926-4522.

Provider Finder Member Hub

Provider Finder

Provider Finder Member Hub

Helping your Bright HealthCare patients stay in-network is easy! Find in-network care for your patients.

Bright HealthCare Provider Finder

2022 Downloadable Resources

Download or share these onboarding resources with your practice staff:

2022 Welcome Guide

English

Spanish

2022 Provider Resource Guide

English

Spanish

2022 Quick Reference Guide

English

2022 Sample ID Cards

Medicare Advantage Sample IDs

HMO

PPO

Employer Sample IDs

Arizona

Colorado

All others

Pharmacy Resources

2022 Pharmacy Updates

New pharmacy benefits manager, new specialty pharmacy, electronic prior authorization and more

2022 Pharmacy Updates

Additional Provider Resources

Member ID Lookup

Individual and Family Members

Medicare Advantage Members - Call 844-926-4522

Claims and Payment

Learn how to set up payment accounts and how to submit, track and manage claims.

Claims and Payment

Provider Disputes

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:

  • Payment disputes
  • Contractual denials
  • Allowable rate disputes
  • Medical necessity denials
  • Missing prior authorization

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.

Utilization Management

Find more information on Bright HealthCare's clinical programs, including prior authorizations and how to refer your patients for case management.

Utilization Management

Sharing or Updating Provider Data

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.

Roster Submissions

Training

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.

SNP Training and Attestation

NEW PAYER ID Effective 1/1/22

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

Patient Programs

Access program information for your patients to lower disease burden measures.

Care Management Referral Form

Provider Communications

Find New Policies and FAQs here:

In-Office Laboratory Testing Payment Policy (Effective 10/1/2021)

Out of Network Payment Policy

Electronic Medical Record FAQ

Change Healthcare Coding Advisor Program
To learn more about this program, please review this FAQ

To search additional policies, please visit Availity.

Dot spacer

Additional Questions?

 

Contact Bright HealthCare Provider Services

 

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