Claim
Claim Form - Medical - HMO-POS-Direct Access – EPO – OMNIA Health Plans
Horizon HMO, Horizon POS and Horizon Direct Access, Horizon EPO and OMNIA Health Plan members use this form for medical claims. ID: 0834
Claim Form - Medical - PPO-Traditional
Members of Horizon BCBSNJ PPO or Traditional plans use this form to file claims. ID: 7190
Claim Form - Medical - Traditional (SHBP)
New Jersey SHBP members with a Traditional plan use this form to file claims. ID: 0704
Prescription Drug Claim Form - Prime Therapeutics
Use this claim form for prescriptions filled by Prime Therapeutics. Prime Therapeutics LLC is an independent company providing pharmacy benefit management services for Horizon BCBSNJ members. ID: 3272
