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PARTICIPATING PROVIDER CLAIM RECONSIDERATION PROCESS
As a Participating Provider, you have the right to initiate a Claim Reconsideration Request and seek to have
Bravo Health review its claim adjudication decisions. You have sixty (60) days from the date you received
Bravo Health’s claim denial or claim adjustment notice to request a review of our administrative decisions.
Your Claim Reconsideration Request must be in writing and include the following information:
1. The name of the Member, the Member’s date of birth, and the Member’s Bravo Health identification
number;
2. Provider name and address;
3. A copy of the specific claim and our payment adjustment or denial notice;
4. An explanation of the specific service and dates of service for which payment was adjusted or denied
and, using applicable Provider Agreement provisions, your rationale for requesting a
reconsideration.
Your request should be sent to the following address:
Bravo Health
Claim Reconsideration Team
P. O. Box 26038
Baltimore, MD 21224
Bravo Health will review your request and respond within 60 days of receipt of the request. If our original
claim adjudication decision is reversed, in whole or in part, the claim will be reprocessed and paid within 60
days. If our original claim adjudication decision is upheld, we will respond in writing and include a reason
for the reconsideration denial. If you disagree with the outcome of the claim reconsideration process, or for
any dispute other than claim reconsideration, you may pursue dispute resolution as described on page 67 of
this Manual and in your Agreement with us.
You do have the right, in most instances, to file an appeal on behalf of a Bravo Health Member provided
the Member has specifically authorized you to act on his/her behalf. A copy of the Member’s written
authorization must accompany the appeal.
