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)

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 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.

Provider Services	1-888-444-0501
Behavioral Health	1-888-444-0422
Case Management	1-888-621-5894
Member Services	1-833-272-8360
Pharmacy Services	1-855-457-0222
24/7 Nurse line	1-888-444-0036
Utilization Management	1-800-664-2583

For 2023, Braven Health Medicare Advantage plans are available to beneficiaries who reside throughout New Jersey.

• Braven Medicare Choice (PPO) is offered to beneficiaries who reside in all 21 NJ counties.
• Braven Medicare Freedom (PPO) is offered to beneficiaries who reside in Bergen, Essex, Hudson, Middlesex, Monmouth, Ocean, Passaic and Union counties.
• Braven Medicare Plus (HMO) is offered to beneficiaries who reside in Bergen, Essex, Hudson, Middlesex, Monmouth, Ocean and Union counties. This plan uses a subset of Horizon Managed Care Network providers.
• Braven Medicare Group w/Rx (PPO) and Braven Medicare Access Group (HMO-POS) are offered to group employers with locations in New Jersey.

All Braven plans, except Braven Medicare Plus (HMO), include coverage for out-of-network services.

Braven Health 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 have not 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 that 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.

Braven Health member ID cards will include a plan-specific prefix followed by “3HZN” and eight numbers. Braven Health patient ID cards can be viewed, downloaded and printed from NaviNet.

• B7U prefix for Braven Consumer (PPO) plans
• B7T prefix for Braven Consumer (HMO) plans
• B7V prefix for Braven Group (HMO-POS) plans
• B7W prefix for Braven Group (PPO) plans

You can verify your patients’ coverage and plan details through NaviNet. Below is a summary of benefits by plan type.

Braven Plan	PCP Selection	Referrals	OON Benefits
Braven Medicare Plus (HMO)	Required	Not Required	No
Braven Medicare Choice (PPO)	Optional, but recommended	Not Required	Yes
Braven Medicare Freedom (PPO)	Optional, but recommended	Not Required	Yes
Braven Medicare Group (PPO)	Optional, but recommended	Not Required	Yes
Braven Medicare Group (HMO-POS)	Optional, but recommended	Not Required	Yes

HearUSA manages the audiology and hearing aid services provided to patients enrolled in Braven Health℠ Medicare Advantage and Braven Health PPO plans.

For Braven Health Medicare Advantage plans, HearUSA:

• Is the exclusive in-network provider for annual routine hearing exams (CPT® code 92257), and fitting/evaluation for a hearing aid (CPT® code V5070), and hearing aids.
• Administers the benefits for audiology services and hearing aids.
• Processes claims on our behalf for Braven Health Medicare Advantage plans.

Members and providers may call HearUSA at 1-800-442-8231 to verify benefits, find a convenient HearUSA network provider location, and/or schedule services to be provided at a HearUSA network location.

The routine hearing exam (CPT® code 92257) must be performed by an audiologist. A fitting/evaluation for a hearing aid (CPT® code V5070) and hearing aids must be provided by a licensed hearing aid dispenser/specialist. Members get the most out of their benefits by using HearUSA network audiologists and licensed hearing aid providers.

Coverage Details and Claim Submission Details

Review the information in the table below to understand benefit levels and claim submission information for the annual routine hearing exams (CPT® code 92257), fitting/evaluation for a hearing aid (CPT® code V5070), and hearing aids.

Braven Health Plan	In Network (INN) Coverage	Out-of-Network (OON) Coverage	Claim Submission
Braven Medicare Plus (HMO)	Members must use HearUSA network providers.	Benefits are not available for services provided by OON providers.	Submit all claims to HearUSA.
Braven Medicare Access Group (HMO-POS) Braven Medicare Access Group w/Rx (HMO-POS)	Members obtain INN services and receive hearing aid discounts through HearUSA.	Members may use OON providers ONLY for exams, but will incur higher out-of-pocket expenses. No benefits are available for hearing aids received from OON providers.	Submit OON hearing exam claims to Braven Health. Submit INN hearing exam claims and all hearing aid claims to HearUSA.
Braven Medicare Choice (PPO) Braven Medicare Freedom (PPO) Braven Medicare Group (PPO)) Braven Medicare Group w/Rx (PPO)	Members obtain INN services and receive hearing aid discounts through HearUSA.	Members may use OON providers for exams and hearing aids but will incur higher out-of-pocket expenses.	Submit all claims to HearUSA.

HearUSA Claim Submissions

Submit claims for annual routine hearing exams (use CPT 92257), fitting/evaluation for a hearing aid (use HCPCS V5070), or hearing aids by secure email to HearUSA at networkclaims@hearusa.com or mail to:

• HearUSA Network Claims
  PO Box 31927
  West Palm Beach, FL 33420

Claims for services provided by other specialties or for services other than annual routine hearing exams, fitting/evaluation for a hearing aid should be submitted to Braven Health.

Braven Health Claim Submissions

Submit claims electronically to Braven Health using Payer ID 84367 or mail to:

• Braven Health
  PO Box 820
  Newark NJ, 07101-0820

Hearing Aid Benefit Summary

For in-network services (within the HearUSA network), members must call HearUSA to obtain hearing aids (purchase and repair) from any HearUSA in-network provider at a discount.

For calendar year 2023, members receive a benefit allowance of up to $1,250 for expenses incurred in purchasing and/or repairing a hearing aid.

• Up to $750 towards hearing aid purchases and/or repairs for the first ear, and
• $500 toward a second hearing aid for the other ear.
• Also includes 1 year of free batteries.

The benefit information provided here is not a guarantee of reimbursement. Claim reimbursement is subject to member eligibility and all member and group benefit limitations, conditions and exclusions. You can use our Eligibility and Benefits Cost Share Estimator on NaviNet® to confirm member-audiology benefits and hearing aid benefit amounts before providing services.

The information provided here is not intended to replace or modify the terms, conditions, limitations, and exclusions contained within health, dental or vision benefit plans issued or administered by Horizon BCBSNJ. In the event of a conflict between the information contained in this document and your plan documents, your plan documents shall control.

Audiology Distribution, LLC, doing business as HearUSA and HearUSA centers are independent from and not affiliated with Braven Health or Horizon Blue Cross Blue Shield of New Jersey. HearUSA administers hearing benefits and provides related products and services through their network of independently practicing audiologists, hearing care professionals and company-owned hearing centers for eligible Braven Health members.

Prime Therapeutics administers the pharmacy benefits and pharmacy network.

Drug Authorizations

To determine which drugs are covered and to request prior authorizations, access our Drug Authorization tool on NaviNet. Sign on to NaviNet and access Drug Authorizations from the Horizon BCBSNJ Plan Central page, under Work Flows. If you need access to the Drug Authorization tool, please work with your office’s NaviNet Security Officer to get Security Officer level access.

You can also call Prime Therapeutics at 1-800-693-6651 with questions and to determine coverage.

Prescription Drug Formulary

The Braven Health Formulary is enhanced for 2023 with select drug changes.

• Summary of 2023 Braven Health Plan Formulary Changes and listing of drugs currently approved for common conditions.
• Full Braven Health Plan Formulary

Braven Health follows many of Horizon’s administrative processes, policies and procedures, 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: Submit through our online Utilization Management Tool, accessed via NaviNet.
• Reimbursement at your current Horizon contracted rates
• Utilization management