Braven Health℠

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.netNaviNet.net opens a dialog window‌.

Braven Health member IDs 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 HealthBraven Health opens a dialog window‌.

Overall Braven Health does not create significant administrative changes for participating providers. Many processes remain the same as they are for the existing Horizon BCBSNJ Medicare Advantage line of business, including:

• Authorizations and appeals
• Behavioral Health: All behavioral health services are managed by the Horizon’s BCBSNJ 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.
• 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.

Effective 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.

For more information visit the Braven Health EDI page.