Utilization Management

Bright HealthCare’s Utilization Management (UM) program exists to promote care that is evidence-based, affordable for your patients, a cost-effective use of healthcare resources, and in-network.

 

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Submit Prior Authorizations Online

Submitting authorizations online is faster, easier, and offers many additional features not available when submitting via fax:

• Immediate confirmation of a successful authorization submission

• A reference number for each authorization

• Ability to view the status of an authorization

• Automatic approval for services that only need a network validation (Level 1 review)

 

How to submit prior authorizations online

Why you should submit prior authorizations online

Not all services require prior authorization

 

Instructions for Submitting Authorizations Online via Availity

 

  1. Log in to
  2. Click Patient Registration | Authorization & Referrals in the top left of the screen
  3. The Authorization & Referrals page displays
  4. Click Auth/Referral Inquiry or Authorizations to begin an electronic authorization request

For detailed step-by-step instructions on submitting authorizations electronically, please review the user guide on under payer spaces.

 

IFP Prior Authorization Resources

Commercial Plans Prior Authorization List - Florida Markets

Commercial Plans Prior Authorization List - NON-Florida Markets

Medical Inpatient Form

Medical Inpatient Form - Oklahoma

Medical Outpatient Form

Medical Outpatient Form - Oklahoma

Behavioral Health Form

Behavioral Health Inpatient Form - Oklahoma

Behavioral Health Outpatient Form - Oklahoma

Continuity of Care Request Form

IFP Prior Authorization List Changes

Utilization Management Program Phone: 1-844-990-0375

 

Small Group Prior Authorization Resources

Small Group Plans Prior Authorization List - Florida Markets

Small Group Plans Prior Authorization List - NON-Florida Markets

Medical Inpatient Form

Medical Inpatient Form - Oklahoma

Medical Outpatient Form

Medical Outpatient Form - Oklahoma

Behavioral Health Form

Behavioral Health Inpatient Form - Oklahoma

Behavioral Health Outpatient Form - Oklahoma

Continuity of Care Request Form

 

MA Prior Authorization Resources

HMO Prior Authorization List

PPO Prior Authorization List

HMO-POS Prior Authorization List

DSNP Prior Authorization List

Medical Inpatient Form

Medical Outpatient Form

Behavioral Health Form

Utilization Management Program Phone: 1-844-929-0162

 

Need to Make a Change to an Authorization?

 

The authorization change request form can be used when Providers need to change any of the following items on an existing authorization.

  1. Servicing Provider or Facility Name

  2. Dates of Service for a planned procedure

  3. The number of days/units/visits needed for a specific service

Use this form when you need to change information on a pending or approved authorization. Note that the form is not intended to add codes to an authorization. For an approval of additional services, please submit a new authorization request.

Case Management Bright HealthCare case management referrals can be submitted via phone or fax using the Case Management Referral Form. IFP Request via phone: 1-888-658-6818 MA Request via phone: 1-888-668-0804 Submit via fax: 1-833-903-1607

 

Bright HealthCare Data Regarding Approvals and Denials of Prior Authorization Requests

Colorado

Per prior authorization bill HB19-1211 or C.R.S. § 10-16-112.5, the state of Colorado requires carriers and organizations to publish prior authorization data.

 

Questions? Contact Bright HealthCare Provider Services

Individual and Family Plans Call: 866-239-7191

Medicare Advantage Plans Call: 844-223-8380