The online portal is available to submit prior authorizations. Check the prior authorization lists here to assure an authorization is needed and/or if clinical documentation is required to make a determination.
Authorization Requirement Changes
REMINDER: All out-of-network providers require an approved authorization for payment for any service provided to a Bright HealthCare Member.
Below is a summary of the changes, effective July 1, 2021, to Bright HealthCare’s prior authorization requirements:
Authorization No Longer Required
Colonoscopy*, endoscopy*, and cystoscopy procedures (~75 codes)
*virtual colonoscopy and capsule endoscopy DO still require authorizationSelect ophthalmology procedures
66982: XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX WO ECP
67028: INTRAVITREAL NJX PHARMACOLOGIC AGT SPX
67042: VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA
67108: RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH
67228: TREATMENT EXTENSIVE RETINOPATHY PHOTOCOAGULATIONSelect steroid injections
20610: ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
20611: ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/USNavigational bronchoscopy
31627: NAVIGATIONAL BRONCHOSCOPY
C9751: BRONCH RIGID/FLEX TRANSBRON ABL LESThyroidectomy
60220: TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
Full Clinical Review Required
Full clinical review required for the procedures below to align with similar procedure codes.
Select cosmetic skin graft procedures
15734: MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK
15738: MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTRSelect PET imaging procedures
78816: PET IMAGING FOR CT ATTENUATION WHOLE BODYOther procedures
64625: RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
77263: RADIATION THERAPY PLANNING, COMPLEX
Network Validation Review Required
Authorization will still be required for the procedures below, but only the network status of the servicing providers will be considered in the review.
- Select 3D imaging procedures
76376: 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
76377: 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
New Codes
Bright HealthCare maintains our authorization list with the latest CPT and HCPC codes. As new codes become available, we perform a review of the service and designate authorization requirements. Click here or please go to Availity for the list of new codes.