Utilization Management
If you're looking for Utilization Management forms for your doctor, you can find them here.
Consent Form - Out-of-Network
This form must be completed by a referring doctor/other health care professional and signed by the Braven Health member at the time a referral is made to a nonparticipating doctor, facility or other health care provider (including clinical labs).
ID: 40054
Braven Health Continuity of Practitioner Care for Medical Benefits
Use this form to request continuity of practitioner care for medical benefits for patients enrolled in Braven Health plans.
ID: 40050
Professional/Institutional Inquiry, Request & Adjustment Mail Form
Professional and Institutional providers may use this form to mail us inquiries, claim adjustment requests, or requests to resolve or provide information about issues related to patients enrolled in Braven Health plans.
ID: 40111
Professional Provider Inquiry, Request & Adjustment FAX Form
Professional providers may use this form to FAX us inquiries, claim adjustment requests, or requests to resolve or provide information about issues related to patients enrolled in Braven Health plans.
ID: 40112
Hematologist/Oncologist Inquiry, Request & Adjustment FAX Form
Hematology/Oncology providers may use this form to FAX us inquiries, claim adjustment requests, or requests to resolve or provide information about issues related to patients enrolled in Braven Health plans.
ID: 40114
Institutional/Facility Inquiry, Request & Adjustment FAX Form
Institutional providers may use this form to FAX us inquiries, claim adjustment requests, or requests to resolve or provide information about issues related to patients enrolled in Braven Health plans.
ID: 40113