Network Administrative Guidelines

Who We Are

Brighton Health Plan Solutions (BHPS) is an innovative health care enablement company on a mission to improve how health care is accessed and delivered in the self-funded health plan market. It offers several industry-leading brands, including MagnaCare and Create®, accessing the Brighton Health Network (BHN).

Contents

• Claim Reconsideration and Dispute Resolution
• Claims Process
• Credentialing
• ID Cards
• Medical Management/Quality Assurance/Utilization Review
• Precertification/Prior Authorization
• Provider Responsibilities
• Reimbursement
• Subrogation and Coordination of Benefits (COB)
• Transition of Care/Continuity of Care
• General Compliance and Fraud, Waste, and Abuse Requirements
• New York State IPA Participating Provider Agreement
• New Jersey ODS Participating Provider Agreement