Get Bravowell Prime

The Bravowell Prime form is essential for participants wishing to appeal their wellness results. This comprehensive guide will walk you through each section of the form to ensure that you complete it correctly and efficiently.

Follow the steps to successfully complete the Bravowell Prime form.

1. Press the ‘Get Form’ button to access and download the Bravowell Prime form, which you will need to fill out comprehensively.
2. Participants must provide their contact information, including their name, Bravo Member ID, address, and phone numbers. Ensure you sign the form to confirm the accuracy of the information provided.
3. Indicate the type of appeal you are filing by selecting either a disputed result or a medical exception. Check the appropriate box as it applies to your situation.
4. Identify any appeal criteria by placing a checkmark next to those that apply to your specific plan. Include your original results in the designated columns.
5. For those filing a medical exception, your healthcare provider must complete the necessary sections detailing any medical conditions that hinder meeting the set goals.
6. Have your healthcare provider provide their contact information and signature. This step is crucial, as appeals cannot be processed without this information.
7. Finally, fax or mail your completed form to Bravo Wellness as per the given instructions. Ensure to keep a copy of the fax confirmation for your records.

Complete the Bravowell Prime form online today to initiate your appeal process.