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