Bright Health Plan 101

Supplemental Benefits
Utilization Management

CareRadius

Acronyms

100

Provides affordable health insurance with a great experience for everyday individuals.

What is Bright Health?

100

Pharmacy Benefit Manager.

What is Elixir?

100

Types of authorization requests.

What is Inpatient, Concurrent, Prior Auth/Pre-Cert, and Retro?

100

CareRadius VPN network site.

What is Barracuda?

100

IFP and MA

What is Individual Family Plan and Medicare Advantage?

200

Bright Health Values

What is Purposeful, Authentic, Brave, Positive, Respectful?

200

Program to keep Medicare Advantage members active and healthy.

What is Silver&Fit?

200

These CPT codes are approved if:

The servicing provider is in-network

The place of service is in-network

What is Level 1 Prior Authorization?

200

Can be used by multiple internal partners, as well as submitting referrals between care management programs.

What is Referral Survey?

200

TAT

What is Turn around times?

300

Making healthcare right. Together.


What is Bright Health Mission?

300

Hearing and DME

What is Homelink?

300

EOC/COC

What is Evidence of Coverage and Certificate of Coverage?

300

Provides a mechanism for the user to view all CR® member documentation regardless of the workflow record the documentation is associated with.

What is All Documents tab?

300

OON

What is Out of Network?

400

BHP President and CEO

Who is G. Mike Mikan?

400

Circulation

What is the company that provides free rides for non-emergency medical transport for both MA and IFP members?

400

Governing body who accredits and certifies healthcare industries.

What is URAC-Utilization Review Accreditation Commission?

400

Allows you to enter requests for treatment from either a provider or a member requesting care?

What is Authorization process?

400

SCA

What is Single Case Agreement?

500

BHP Current 13 States

What is- Alabama, Arizona, California, Colorado, Florida, Illinois, Nebraska, New York, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee?


500

Company contracted with BHP to provide nutritious meals for members who have had an admission to the hospital.

What is GA Foods?

500

BHP Medical Directors

Who is Dr. Christine Gilroy, Dr. Gerry Davis, Dr. Irene Baral, Dr. Cory Coldwell?

500

The process begins when the Escalation Nurses in Kansas City are notified of a request for OON services.

What is a Redirection survey?
500

IRO

What is Independent Review Organization?