Braven Health is a new insurance company created through a partnership with Horizon BCBSNJ, Hackensack Meridian Health (HMH) and RWJBarnabas Health. Braven Health, an affiliate of Horizon BCBSNJ, offers Medicare Advantage plans in certain New Jersey counties. Plans are effective January 1, 2021.
What you need to know about Braven Health℠
Braven Health consumer plans are offered to Medicare beneficiaries who reside in the following New Jersey counties: Bergen, Essex, Hudson, Middlesex, Monmouth, Ocean, Passaic and Union. Braven Health also offers Medicare Advantage plans to employer groups for their retirees when the headquarters of the employer group is within one of the eight New Jersey counties listed above.
In addition to offering Braven Health plans, we will continue to offer Horizon BCBSNJ Medicare Advantage plans in all 21 New Jersey counties.
If you are a participating provider for Horizon BCBSNJ Medicare Advantage plans, Braven Health has been added as a new plan offering that you will service.
Members enrolled in Braven Health plans have in-network access to providers in our Horizon Managed Care Network and Horizon Hospital Network throughout our local service area (New Jersey and participating counties Delaware, New York and Pennsylvania).
Though created through our partnership with HMH and RWJBarnabas Health, Braven Health members are not restricted to using, or encouraged to use, HMH or RWJBarnabas Health-affiliated providers and hospitals.
Below is information that will help you with your day-to-day interactions with us.
Participation in Braven Health plans is based on providers’ current participation status with existing Horizon Medicare Advantage plans.
- Braven Medicare Choice (PPO), Braven Medicare Freedom (PPO), Braven Medicare Group (HMO-POS) and Braven Medicare Access Group (HMO-POS) plans will use the broad Horizon Managed Care Network and the broad Horizon Hospital Network.
- Braven Medicare Plus (HMO) will use the same subset of the Horizon Managed Care Network and the Horizon Hospital Network used by Horizon BCBSNJ Medicare Blue Advantage (HMO) plans.
Our online Doctor & Hospital Finder indicates network participation status in Braven Health plans.
|Braven Health plan||You are participating with this plan if …|
|Braven Medicare Choice (PPO)
Braven Medicare Freedom (PPO)
Braven Medicare Group (HMO-POS)
Braven Medicare Access Group (HMO-POS)
|You participate in the broad Horizon Managed Care Network or the Horizon Hospital Network|
|Braven Medicare Plus (HMO)||You participate in the subset of the Horizon Managed Care Network or the Horizon Hospital Network that is used for the Horizon Medicare Blue Advantage plan.|
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 terminate participation in the Horizon Managed Care Network or the Horizon Hospital Network completely.
Braven Health will offer the following Medicare Advantage plans for January 1, 2021.
- Braven Medicare Plus (HMO)
- Braven Medicare Choice (PPO)
- Braven Medicare Freedom (PPO)
- 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.net.
Braven Health member IDs will 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 8 numbers.
Braven Health and Horizon BCBSNJ are offering separate Medicare Advantage plans.
- Braven Health is offering brand new Medicare Advantage plans for 2021 in eight New Jersey counties.
Review more information about Braven Health .
Overall Braven Health will not create significant administrative changes for participating providers. Many processes will remain the same as they are today for the existing Horizon BCBSNJ Medicare Advantage line of business, including:
- Authorizations and appeals
- Behavioral Health: All behavioral health services will be managed by the Horizon’s BCBSNJ behavioral health program.
- Case Management.
- Credentialing and Recredentialing.
- Electronic Funds Transfer (EFT) Transactions.
- Network operations and provider services.
- Policies, including medical polices.
- Prior Authorization: Requests will continue to be submitted through our online Utilization Management Tool, accessed via NaviNet.
- Access a list of Medicare Advantage services that require prior authorization.
- Reimbursement: Your current Horizon BCBSNJ contracted rate will continue.
- Utilization management.
For Braven Health members who are contact attributed to Hackensack Meridian Health through their value-based program, Hackensack Meridian Health Partners will perform some Utilization Management and Case Management services.
Coming January 1, 2021
- Provider Services phone number: 1-888-444-0501. Providers that call the existing Horizon BCBSNJ services phone numbers will still be able to have their Braven Health needs addressed.
- Behavioral health program dedicated phone number:1-888-444-0422.
- Braven Health Payer ID is 84367. Providers will need to utilize a separate Payer ID for Braven Health claims. All trading partners and direct submitters will need to register for Braven Health EDI prior to January 1, 2021.
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.
One difference for providers is that Braven Health, as a new insurance company, will have its own Payer ID (84367), separate from Horizon BCBSNJ.
- Trading partners are currently enrolling and testing EDI capabilities with us for January 1, 2021.
- Direct submitters should register with Braven Health EDI capabilities.
For more information visit the Braven Health EDI page.