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Help Center FAQs

How do I submit a claim?

Choose the type of claim you'd like to submit.

  • You can submit out-of-network medical claims using the Horizon Blue App (which does not require a claim form) or by mail. This includes claims for the following:

    • Behavioral health (mental health and substance use disorders)
    • Prescriptions
    • Eyeglasses
    • Durable medical equipment like breast pumps, sleep apnea machines, diabetic supplies, orthotics, etc.


    Submitting a Medical or Behavioral Health Claim

    To submit a medical or behavioral health claim using the Horizon Blue App, sign in and tap Claims, then Submit a Claim.

    To submit a medical or behavioral health claim by mail:
     

    1. For all members except State Health Benefit Program (SHBP) or School Employees’ Health Benefits Program (SEHBP), download and complete the Horizon Health Insurance Claim Form

      For State Health Benefit Program (SHBP) or School Employees’ Health Benefits Program (SEHBP) members, download and complete the SHBP/SEHBP Medical Plan Claim Form
       
    1. Follow the instructions on the claim form to include an itemized bill. This includes:  
      • Patient name
      • Member ID number
      • Date of service
      • Diagnosis code(s)
      • Procedure code(s)
      • Place of service
      • Total charge

      Mail medical claims to the address on the claim form.
       

    1. Mail behavioral health claims to:

      Horizon Blue Cross Blue Shield
      Horizon Behavioral Health
      P.O. Box 10191
      Newark, NJ 07101-3189
       
    2.  

    For Medicare claims, you must also include a Medicare Explanation of Benefits (EOB). An Explanation of Benefits (EOB) is the notice that your Medicare Advantage Plan or Part D prescription drug plan typically sends you after you receive medical services or items. You only receive an EOB if you have Medicare Advantage or Part D.

     

  • You can submit out-of-network dental claims by mail only.

    For all members except State Health Benefit Program (SHBP) or School Employees’ Health Benefits Program (SEHBP), download and complete the Claim Form - Dental. Mail it to the address on the form.

    For State Health Benefit Program (SHBP) or School Employees’ Health Benefits Program (SEHBP) members, download and complete the Dental Claim Form. Mail it to the address on the form.

     

  • You can submit out-of-network prescription claims by mail only. Follow these steps:

    1. Sign in to HorizonBlue.com.
       
    2. Under Doctors & Care, click Prescriptions.
       
    3. If you see Go to Prime Therapeutics: Mail the Prescription Drug/COVID-19 At Home Test Kit Claim Form to the address on the form.
       
    4. If you do NOT see Go to Prime Therapeutics: Follow the instructions on screen to be redirected to the appropriate vendor. You can obtain the prescription claim form from their website, or call the number on your prescription drug identification card.

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Last updated:

Aug 19,2022

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