Braven Health℠

Starting October 15, 2022, Medicare-eligible beneficiaries who reside in all 21 New Jersey counties can enroll in a Braven Health Medicare Advantage plan for coverage beginning January 1, 2023.

What You Need to Know

• You already participate with Braven Health Medicare Advantage (MA) plans if you participate in our Horizon Managed Care Network or Hospital Network.
  
  
• You can provide services to Braven Health members.
  • Braven Health (PPO) plans use the broad Horizon Managed Care Network and Horizon Hospital Network.
  • Members enrolled in our Braven Medicare Plus (HMO) plan (offered only in Bergen, Essex, Hudson, Middlesex, Monmouth, Ocean, and Union counties) use a subset of the Horizon Managed Care Network or a subset of the Horizon Hospital Network.
  
  
• You can confirm your 2023 Braven Health participation status in our Doctor & Hospital Finder.
  
  
• Braven Health has its own Payer ID (84367), different from Horizon.

Take Action Now:

• Check to make sure you are registered for Braven Health EDI prior to January 1, 2023
  • All trading partners and direct submitters (who are not already registered) must register for Braven Health EDI prior to January 1, 2023 to submit and receive electronic transactions related to Braven Health members.
  
  
• Register to attend one of our webinars.
  • Professional medical practices: Register to attend a Braven Health webinar.
  • Behavioral Health practitioners and ancillary providers: Register for one of our Quarterly/BiAnnual Update or Orientation sessions, which will include information about Braven Health.
  • Hospital staff: Attend an online Hospital Forum session in November, which will include information about Braven Health.

If you participate in our broad Horizon Managed Care Network or our Horizon Hospital Network, you are participating with:

• Braven Medicare Choice (PPO)
• Braven Medicare Freedom (PPO)
• Braven Medicare Group (HMO-POS)
• Braven Medicare Access Group (HMO-POS)

If you participate in the subset of the Horizon Managed Care Network or the subset of the Horizon Hospital Network, you are participating with:

• Braven Medicare Plus (HMO)
  This plan will continue to be offered only in Bergen, Essex, Hudson, Middlesex, Monmouth, Ocean, and Union counties in 2023.

Visit our Doctor & Hospital Finder for information about your participation with our various plans.

Physicians and other health care professionals participating in the Horizon Managed Care Network, and hospitals participating the Horizon Hospital Network, cannot choose to opt out of participation with Braven Health plans. The only option to not participate with Braven Health plans and other Horizon Medicare Advantage plans would be for a physician, health care professional or hospital to completely terminate participation in the Horizon Managed Care Network or the Horizon Hospital Network.

Braven Health, as a separate insurance company, has its own Payer ID (84367), separate from Horizon BCBSNJ. Use this separate Braven Health Payer ID for claims and other electronic transactions with Braven Health.

If you haven’t already registered for Braven Health EDI, please access our dedicated EDI webpage to do so immediately.

If you are a provider using a trading partner (clearinghouse or vendor) you need to:

• Contact your trading partner to confirm they have completed the required Braven Health EDI registration process.
• Complete and submit the Braven Health Electronic Remittance Advice (835) Enrollment form for your practice.
• Visit our dedicated EDI webpage for information.

For the 2022 benefit year, the following Braven Health Medicare Advantage plans are available to beneficiaries who reside in Bergen, Essex, Hudson, Middlesex, Monmouth, Ocean, Passaic and Union counties.

• Braven Medicare Choice (PPO)
• Braven Medicare Freedom (PPO)
• Braven Medicare Plus (HMO) (not available in Passaic County)
• Braven Medicare Group (HMO-POS)
• Braven Medicare Access Group (HMO-POS)

Coverage for out-of-network services depends on the plan design.

Member ID Cards

You can verify your patients’ coverage and plan details through NaviNet. Images of Braven Health member ID cards can be viewed, downloaded and printed from NaviNet.

Braven Health member ID cards follow the existing Horizon BCBSNJ CCID convention. Following a plan-specific prefix, all Braven Health member ID numbers will include the value “3HZN”, followed by eight numbers.

Braven Health and Horizon BCBSNJ offer separate Medicare Advantage plans.

Review more information about Braven Health.

Overall, Braven Health follows many of the same administrative processes, policies and procedures we have in place for the Horizon Medicare Advantage plans, including:

• Authorizations and appeals
• Behavioral Health: All behavioral health services are managed by the Horizon’s behavioral health program
• Case Management
• Claims
• Credentialing and Recredentialing
• Electronic Funds Transfer (EFT) Transactions
• NaviNet
• Network operations and provider services
• Policies, including medical polices
• Prior Authorization: Requests should continue to be submitted through our online Utilization Management Tool, accessed via NaviNet
• Use our Prior Authorization Procedure Search Tool to see which services require prior authorization.
• Reimbursement is the same as your current Horizon BCBSNJ contracted rate
• Utilization management

Specific information about Braven Health

Braven Health Payer ID is 84367. Providers must use a separate Payer ID for Braven Health claims. All trading partners and direct submitters must be registered for Braven Health EDI, as well as Horizon EDI.

If you use a clearinghouse/vendor to send and receive electronic transactions, please check to ensure that they have completed the required Braven Health EDI registration process. Delays in registration will impact your electronic connectivity, including claim transactions, with us for your Braven Health patients.