---

---

A provider dispute form is available on the Bright Health website for use by both in-network and out-of-network providers:

1. Select "For Providers" at the top of the page
2. Select "Access provider resources"
3. Scroll down to "Additional provider resources"
4. Select "Provider Disputes Form" under "Claims and Payment"

The online form should be completed for each member seprately. Once the form is submitted, Bright Health will provide a tracking number with the received date. Please note that it may take 1-2 days for the information to show in their system. The turnaround time for a response to the dispute form is approximately 45 days at which time a resolution letter will be sent to the submitter with the outcome. 

---