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Welcome to Bright Health 2021 Provider Guide ¿Prefiere leer esta guía en español? Visite Availity.com, a partir de otoño.
A new approach to “We believe the foundation of good healthcare is a
strong relationship between people and their doctors.”
health insurance
-Bob Sheehy, Bright Co-founder and Executive Chairman
Let’s make healthcare better, together.
Bright Health is putting the focus in healthcare back where it belongs – on the patient and their provider. The Bright Health Journey
Our exclusive network brings our members coordinated care from quality providers like you. Together,
we work hand-in-hand to bring our members the best possible care at the best possible price. to Your Community
Simple, personal, affordable
We respect the close relationship between a provider and their patients. To support the provider- Bright Health was founded In 2017, we introduced our Our next step was to expand
patient connection, we built our plans around three core principles: in 2016 on the idea that first health insurance plans and prove that our Care
we could make healthcare in Colorado, offering a new Partner concept would work
Simple: We created a close network of high-performing providers and hospitals to give our more simple, personal, and and affordable way for in other areas, and it did!
members access to superior, quality care. For our providers, our streamlined online access affordable through close, individuals and families to As of 2020, we’re serving
to the information and services you need helps you create the best care experience for your collaborative relationships get access to great care in 12 states. Next year, we’re
patients. with Care Partners. their community. coming to your community.
Personal: We take pride in being there for you and your patients, where and when you need it.
Live support is always available through our Member and Provider Services hotlines, and we
have dedicated local Provider Relations Representatives who understand your community Our 2020 markets
and needs. Our 2017 markets
Affordable: Our carefully selected networks help improve health outcomes and promote
efficient use of resources. We pass these savings along to our members, which lowers
their out-of-pocket costs and reduces barriers to care. We also focus on copays instead of
coinsurance, so you can collect payment at point of care.
Smart solutions designed with our provider partners in mind
We never require a referral to send a Bright Health member to an in-network specialist.
This helps reduce the administrative burden for providers and their front office staff, as
well as the wait time for your patient to get the care they need.
Let’s grow together
$0 $0regularly
copays for routine preventative care visits encourage patients to visit their provider
and to maintain their health.
Bright Health knows that it’s more important than ever to make quality care affordable and
accessible. We’re excited to partner and grow with your practice. Here are some of the ways we work
Our high network retention rates improve our network quality, enhance care affordability, hard to grow our membership and bring you new patients:
and support appropriate benefit use. Bright Health quickly becomes a trusted partner for
our providers! • We developed a creative marketing strategy that has gained industry recognition for its innovative
approach to consumer engagement
We offer electronic claims management, a streamlined prior authorization process, and
• We proactively guide our members to in-network care, so they can easily navigate to our carefully
easy eligibility and benefit checks so your staff can spend less time on paperwork and
selected group of health systems and providers in each community
more time on patients.
2 3Our Products The Bright Health Network
Here at Bright Health, we offer a variety of health insurance plans designed to be simple, personal, We design our network to offer the best possible care at the best possible price. We collaborate
and affordable. Specific plans vary by market because we custom tailor them to meet the needs of closely with a select group of provider partners in each community and guide our members to seek
each community we serve. care exclusively with those partners. For most plans, Bright Health does not cover out-of-network
services, except for emergency care.
Individual & Family Plans
Better health outcomes through coordinated care
Bright Health offers multiple qualified Individual & Family Plans (IFP) to consumers across the United
States. We partner with health systems to deliver a high-quality experience that makes dealing with Bright Health’s personalized Care Partner networks means we can work closely with members
health insurance simpler for our members, at an affordable price. to help them find the right care, which improves health outcomes. Care is better coordinated,
leading to fewer readmissions and emergency room visits, a reduction in duplicate testing, and a
Sample IFP Plans more seamless care experience.
Lower out-of-pocket costs for members
Gold Silver Bronze Catastrophic
In 2019, we saved our members $43 million dollars on their care, compared to what they would
have paid out-of-network. And those savings have increased every year since 2017.
Silver Plus Bronze Plus
We help guide members to in-network care
Bright Health members get great rates on nearly every kind of care when they stay in-network.
Bronze HSA
To help our members seek care with our Care Partners, we:
Offer live care navigation support to help our members find in-network providers
Medicare Advantage Plans Proactively reach out to members who may need additional support finding in-network care
Bright Health offers Medicare Advantage plans to Medicare eligible consumers in certain markets. Redirect out-of-network requests to in-network providers
We design plans to meet the needs of Medicare patients and help them get great access to care that
fits their budgets. Reach out to members with a high risk of going out-of-network
Educate members who go out-of-network and help transition them back to in-network care
Sample Medicare Advantage Plans
ollaborate with providers to better understand their capabilities and support available
C
Bright Advantage Choice (HMO) Bright Bright Advantage Flex Choice (PPO) to members
Advantage Plus (HMO) Bright Advantage Flex Plus (PPO)
How you can help
Bright Advantage Assist (PPO)
You can help your patients save money with the right in-network care. Use our online Provider
Finder tool at BrightHealthPlan.com to:
• Confirm if a provider or facility is in-network
• Find the right in-network doctor, specialist, or facility based on patient preferences
Learn more about the plans Bright Health is offering We never require referrals for Bright Health members to see in-network specialists. We always
in your community at BrightHealthPlan.com. 2021 encourage members to connect with a Primary Care Provider (PCP) early and talk to them
regularly. But if a member needs a specialist, they can see any doctor in our network without a
plan information will be available October 2020! referral. Some services may require a prior authorization to confirm that both the provider and the
place of service are in-network.
4Let’s get started We’re here for you
We’re excited to partner with you to deliver a unique care experience for your patients and our BrightHealthPlan.com/Provider
members. We’ve developed extensive resources and tools to ease administrative burden and support
Starting in September, visit our Provider Resources website to find the information and resources you
seamless, quality care. Here are some things you can do to get your practice up and running.
need to get ready for Bright Health members. You can:
Prepare for your 2021 in-network participation
• Download our Quick Reference Guide
Here are three easy steps to ensure our partnership gets off to a healthy start.
• Get updates to our policies and procedures
1 3 • Get prior authorization and claims forms
• View sample ID cards for your area
Spread the news Keep your practice data up to Share with your patients
with your staff date with NPPES We’re new in town, so patients …And so much more!
Make sure your whole As of this year, you can attest to the may not know about Bright Health
team knows you are now accuracy of your information in one place or that you’re a participating
a participating provider for all your payors through your NPPES provider. List Bright Health on Provider Services
with Bright Health, so profile. Simply log into your NPPES profile your practice website as an Get fast, live support through Provider Services. Once you start seeing Bright Health members, you
they are prepared to at NPPES.CMS.hhs.gov and make sure all accepted plan for 2021 and
can also inquire about eligibility and benefits, claim status, or prior authorization.
answer patient questions. the information is up to date. Keeping your prepare to tell patients “Yes, we do
profile current can help prevent delays in accept Bright Health plans!”
claim payments and prior authorizations. Individual & Family Plans: 855-453-0434 Medicare Advantage: 844-201-0677
Your Provider Relations Representative
Your key tools Your dedicated, local Provider Relations Representative is here to support you and your patients. See
Availity.com page 13 of this guide for their contact information.
Availity is a multipayer platform that allows Bright Health to integrate with your practice in a secure, Bright Health local educational programs
streamlined way. It offers a wide range of tools and resources to make your life easier.
Local educational programs are available to your staff to help you get up to speed and to provide
After 9/1/2020, log into Availity.com and select Bright Health from the Payer Spaces tab. You can: ongoing support once you begin seeing Bright Health members.
• View news, tools, and resources such as the Provider Manual and Quick Reference Guide Our programs include:
• Verify member eligibility and view benefit details
• Meet Bright Health
• Submit electronic prior authorization requests
• Educating Patients about Bright Health
• Obtain prior authorization forms
• Coding and Claims 101
• File electronic claims, check claim status, and view remittance information
To schedule a session, reach out to your Provider Relations Representative.
BrightHealthPlan.com
The Bright Health website is your best resource to: Support that extends outside the clinic
Bright Health integrates closely with our provider partners to offer seamless, coordinated care
• Learn more about Bright Health’s insurance plans
management, including extra support for those who need it most.
• Search for in-network providers or facilities using our Provider Finder Tool
• View formularies and identify low-cost medication with our Drug Finder tool
6 7FAQ About Bright Health, How do we update our provider or practice information?
Visit NPPES.CMS.hhs.gov to update your NPPES profile. Your NPPES profile collects all your
Plans, and Resources information in one place and makes it available to all your payors, saving you time and energy. Visit
BrightHealthPlan.com/provider to learn more about how to update your NPPES profile or how to
send a roster directly to us.
When can I start seeing Bright Health patients?
The information we currently have on file comes from the roster you provided when we contracted
You can start seeing members once you receive confirmation that you have passed credentialing AND with your practice, but we’re always working to improve our provider data using sources like NPPES.
once the plan is live (January 1, 2021 for new markets). Plan effective date and other contract terms can
be found in your practice or organization’s completed Network Participation Agreement. Please contact
your Provider Relations Representative with any questions. What are Bright Health’s referral requirements?
No referrals are required to send a Bright Health member to an in-network specialist or facility.
How can I find out if my providers have been credentialed? Please refer to the Bright Health Provider Directory on BrightHealthPlan.com for a full list of
in-network providers.
Once a credentialing decision has been made, you will receive a letter notifying you of that decision
within 10 days. If it has been more than 90 days since your provider has been submitted for
credentialing and you have not received a letter, please contact the Bright Health Credentialing team at How do I submit prior authorizations?
Credentialing@BrightHealthPlan.com. Prior authorizations can be submitted electronically through Availity.com. You will receive immediate
confirmation and have easy access to tracking. As a backup option, prior authorizations can also be
Where can I find a copy of the Bright Health Provider Manual? submitted via phone or via fax.
Starting in October, you can find the 2021 Provider Manual on Availity.com under the Bright Health Prior authorization forms, which include the numbers to submit via phone or fax, are located on
Payer Spaces tab.. Availity.com and BrightHealthPlan.com/provider.
Why can I not see my provider in the online Bright Health Where do I submit claims?
Provider Directory? Professional and facility claims can be submitted online through Availity.com or through any other
If you are in a new Bright Health market for 2021, the Bright Health Provider Directory for your area electronic data interface (EDI) clearinghouse. Information on filing claims via mail can be found
will be available October 2020. For providers in new Bright Health markets after October 2020 on BrightHealthPlan.com/provider or in the Provider Quick Reference Guide. Claims cannot be
and for all providers in existing markets, please confirm that your provider has passed credentialing submitted via fax.
through Bright Health. If they have and are not appearing in the Directory, please contact your local
Provider Relations Representative. How can I check the status of a claim?
Claims status can be checked on Availity.com. For additional support, please contact Provider Services.
How can I check member eligibility?
Where can I find our fee schedule?
You can check member eligibility on Availity.com. The following information is required to check
Please refer to your completed Network Participation Agreement for a full fee schedule. If you have
eligibility:
questions about your fee schedule, please contact your local Provider Relations Representative. If you
are contracted with Bright Health through a larger organization, please check with your contact at that
• Requesting provider’s NPI
organization.
• Member ID
• Member first and last name What kinds of health insurance plans are you offering in my area?
• Member date of birth Starting in October, you can find full product details by service area on BrightHealthPlan.com. We
will notify you of your participating plans via fax in August.
If you have additional questions about member eligibility, please contact Provider Services.
Where can I view provider resources and announcements?
Visit BrightHealthPlan.com/provider for access to resources, announcements, and updates.
8 9Let’s create a better patient Did you know? CAHPS results are part of an ongoing initiative to change how CMS pays for
services so that payment focuses on the quality of service instead of the number of services provided.
experience – together Patient satisfaction best practices
Together, we can help Bright Health members increase their access to care, improve their overall Follow these best practices to create and promote quality patient-provider relationships.
experience, and better manage their health.
Access to care
CMS Star Ratings and what it means for you • Have recommendations ready for alternative care locations when patients need to see a provider
The Centers for Medicare and Medicaid Services (CMS) uses a five-star rating system, called Star right away
Ratings, to measure Medicare beneficiaries’ experience with their healthcare and health plans,
including Medicare Advantage (Part C) and prescription drug plans (Part D). You can use our Provider Finder tool at BrightHealthPlan.com to find in-network providers.
Part of Star Ratings consists of the Consumer Assessment of Healthcare Providers and Systems • Offer appointment times outside regular hours and/or allow time slots for walk-in patients
(CAHPS), which includes the Health Outcomes Survey (HOS). HOS is a patient-reported outcomes • Make sure patients don’t wait more than 15 minutes to see their provider
measure that assesses the ability of MA health plan providers to maintain or improve the physical
and mental health of their patients over time. • Contact your patients when they may experience a delay through phone, text, or email
On an annual basis, CMS selects a random sample of members from eligible MA plans to participate Help Bright Health members understand their care experience for better HOS outcomes.
in the survey. They administer HOS to the same sample group twice, one year apart. Certified vendors Patients are more satisfied with their care when their provider explains why they may
administer the survey. Vendors are certified by the National Committee for Quality Assurance (NCQA) experience visit wait times or appointment wait lists.
and CMS.
Manage risks and promote preventative care
HOS covers topics that patients are the most qualified to speak about, such as the communication • Identify fall risks
skills of their providers and how easily they could get the care, tests, or treatments they needed. It
• Manage urinary incontinence
asks patients about the experience of their care, rather than their satisfaction with their care.
• Encourage appropriate physical activity
Why do these surveys matter?
As a provider, you are crucial to our members’ health, Medicare Advantage plan satisfaction, and
their overall healthcare experience. Your interactions with our members represent most of their
care experience. Because the member experience with you is such an integral part of their entire
healthcare experience, the results of CAHPS and HOS offer significant insights and benefits to
providers, members, and us, their health plan.
Questions about CAHPS and HOS?
Think of CAHPS and HOS as tools to help you create a better care experience for both you Visit CMS.gov.
and your patients.
• Stronger relationships between the patient, their provider, and their health plan
• Heightened awareness of patient safety issues, such as fall risks
• Clearer focus on preventative medicine and regular screenings
• Insights on chronic conditions and their care management
• Opportunities to improve communication between all parties
• Increased access to quality care
10 11Easy, fast, and personal
support for all your needs
Visit BrightHealthPlan.com/provider
Check out our website for general information, such as:
• A Quick Reference Guide
• Policies and procedures
• Prior authorization forms
• Claims and payment forms
• Provider Finder and Prescription Drug finder tools
• Sample ID cards
Provider Services
Get fast, live support through Provider Services. Once you start seeing Bright Health
members, you can also inquire about eligibility and benefits, claim status, or prior
authorization.
tear off here
Individual & Family Plans: 855-453-0434 Medicare Advantage: 844-201-0677
Email your Provider Relations Representative
Your dedicated, local Provider Relations Representative (PRR) can help you with questions
about contracts, credentialing, and working with Bright Health. Bright Health has one PRR
Still
for each state. Please contact the PRR for your state.
providerrelationsAL@brighthealthplan.com providerrelationsNY@brighthealthplan.com
providerrelationsAZ@brighthealthplan.com providerrelationsNC@brighthealthplan.com
providerrelationsCO@brighthealthplan.com providerrelationsOH@brighthealthplan.com
have
providerrelationsFL@brighthealthplan.com providerrelationsOK@brighthealthplan.com
providerrelationsIL@brighthealthplan.com providerrelationsSC@brighthealthplan.com
providerrelationsNE@brighthealthplan.com providerrelationsTN@brighthealthplan.com
questions?
Thank you for being a part of the Bright Health
network. We’re excited to partner with you in 2021!
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