How can we help?

Your Horizon plan requires you to receive prior authorization or a referral for certain services or treatments. Take a look at the Explanation of Benefits (EOB) statement. If it includes the Message Code M737 that means your claim has been denied because there was no prior authorization or referral on file for this visit.

If you used an in-network doctor, other health care professional or facility, the provider should have submitted the request for prior authorization or given you a referral.

You can update your additional insurance information by following the steps below:

1. Click Benefits & Coverage.
2. Click Benefits Overview.
3. Click the Coordination of Benefits tab. Note: If you are using a mobile device such as a smartphone, tablet or notebook, you will instead need to scroll down to the bottom of the screen to view Coordination of Benefits and select Yes or No.

Please provide the most up-to-date insurance information for all covered family members to help with the processing of your claims.

If your claim was denied because Coordination of Benefits (COB) information is requested, please call the Horizon BCBSNJ’s Member Services phone number on the back of your member ID card. Depending on your plan, you may also be able to sign in and send us an email or chat with a Member Services Representative.

Generally, this means that your Horizon BCBSNJ plan does not cover that specific treatment or service. To get information about your benefits and eligibility, sign in and follow the steps below:

1. Click Benefits & Coverage.
2. Then click What’s Covered.
3. Make a selection from the Service you may need dropdown menu to view coverage details.

Generally, this means that you went to a nonparticipating doctor and your Horizon BCBSNJ plan does not cover nonemergency services or treatment from out-of-network (nonparticipating) health care professionals. Your Explanation of Benefits (EOB) includes specific information in the Message Codes section about why your claim was denied. To view your EOB, sign in and follow the steps below:

1. Click Claims.
2. Click Statements of Payment.
3. Locate the appropriate claim, and click the claim number hyperlink.
4. Click View Explanation of Benefits.

Under the Detail Information field on the EOB, you will see a column listing the Message Codes that apply to the processing of your claim. There will be a full description of your Message Codes explaining why your claim was denied.

You can view your enrollment information by signing in and following the steps below:

1. Click Benefits & Coverage.
2. Then click Benefits Overview to view the Plan Details for the eligibility status of each enrolled member, as well as the effective date of the plan. You can view your Horizon BCBSNJ medical, dental, prescription and vision plans, as applicable, and the dependents covered under those plans.

If the displayed information is incorrect and you have your Horizon BCBSNJ insurance through your employer, please contact your company’s Benefit Administrator. If you purchased your coverage directly through Horizon BCBSNJ, the Exchange (the federal Marketplace) or the New Jersey State Based Exchange (SBE), please call Horizon BCBSNJ’s Member Services phone number on the back of your member ID card.

If your claim has been denied because we did not receive the Medicare EOB (MEOB), please send the missing MEOB to:

Horizon BCBSNJ
PO BOX 1609
Newark, NJ 07101

Horizon BCBSNJ has up to 30 days to process your claim from the date we received the additional information.If Medicare is not the primary payer for your claims, please call the Horizon BCBSNJ’s Member Services phone number on the back of your member ID card, send us an email, or chat with us.