- June 2021 Updates: COVID-19 treatment cost share waiver
- Reminder: Use correct codes when evaluating for COVID-19
- Policy Update: Antibody Testing Claims
- Update: Members’ cost sharing waived for treatment of COVID-19 through June 2021
- Submitting claims for COVID-19 vaccines delivered in non-traditional medical settings
- Every shot counts – keeping your patients informed about the COVID-19 vaccines
- For Essential Workers, COVID-19 Treatment Covered Under Workers’ Compensation Benefits
- Submitting Pharmacy Claims for COVID-19 Vaccinations
- Update: Prior Authorization Requirements for Inpatient Admissions and Post-Acute Facility Admissions to be Reinstated
- COVID-19 vaccine administration reimbursement at UCCs
- COVID-19 vaccines available in Essex County – Information for your staff and patients
- Reimbursement Policy effective January 1, 2021: Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)
- COVID-19 vaccines will be covered at 100%
- Coverage for antibody infusion therapy
- Waiving Prior Authorization Requirements for Emergent In-Network Inpatient Admissions and Post-Acute Facility Admissions
- Update: Antibody Testing Claims
- Update: Cost-share waiver for telemedicine and COVID-19 testing extended
- Cost Sharing on Claims with Multiple Diagnoses
- Dates for Certain Prior Authorization Waivers Further Extended
- Dates for Prior Authorization Waivers Extended
- New Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769
- COVID-19 Update: Medical Policy Revisions & Implementations
- 72 Doctors, Nurses, Pharmacists and Health Clinicians from Horizon BCBSNJ Answer Governor Murphy’s “HealthCare Professionals Call to Serve”
- New Jersey Pandemic Relief Fund Efforts Get $2 Million Boost from Horizon
- A special message from Howard A. Cutler, Vice President, Healthcare Delivery
- Behavioral Health Continuity During the COVID-19 Public Health Emergency
- COVID-19 Frequently Asked Questions
- Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility Admissions
- Horizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health Professionals
- COVID-19 Update: Authorizations Waived for Oxygen Following ER Discharge
- Reminder to use specific codes when evaluating for COVID-19
- COVID-19 Update: Telemedicine Reimbursement Policy Addenda
- Provisionally Join Horizon BCBSNJ Network(s) to Assist with the COVID-19 Pandemic
- Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions
- Providing Telephonic care with no costs to members
- COVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine Services
- COVID-19 CPT testing codes
- Eliminating Cost Sharing Related to COVID-19 Testing and Evaluation
- Staying Informed: COVID-19 Coronavirus
- Our Commitment
- Join Our NetworksJoin Our Networks
- Join a Horizon BCBSNJ or Horizon NJ Health Network (Physicians and Other Healthcare Professionals )
- Join the Horizon BCBSNJ Network (Ancillary Providers)
- Join the Horizon NJ Health Network (Ancillary Providers)
- Join the Horizon Dental Network
- Our Healthcare Facilities
- AIM Specialty HealthAIM Specialty Health
- Diagnostic Imaging Program
- Frequently Asked Questions
- Groups Enrolled With AIM
- Muskoskeletal Program
- Procedure Codes Reviewed by AIM
- Sleep Disorder Management Program
- Braven Health
- Case ManagementCase Management
- Chronic Care ProgramChronic Care Program
- BlueCard ProgramBlueCard Program
- BlueCard Announcements
- BlueCard Claims
- BlueCard Medical Policy/Pre-Certification Info
- BlueCard Program FAQs
- BlueCard Program Overview
- BlueCard Program Tutorial
- GeoBlue: International Coverage
- How to Identify BlueCard Members
- Dental Services
- EDI & EFT TransactionsEDI & EFT Transactions
- eviCore Health CareeviCore Health Care
- Cardiology Imaging Program
- Molecular and Genomic Testing Program
- Musculoskeletal Program
- Radiation Therapy Program
- Radiology/Imaging Services Radiology/Imaging Services
- Horizon Behavioral Health℠
- Horizon Care@HomeHorizon Care@Home
- About Horizon Care@Home
- Find A Provider
- Home Infusion Therapy
- Prior Authorization/Pre-Service Registration
- Medical Injectables Program
- Patient Health Support
- Pharmacy ProgramsPharmacy Programs
- E-Prescribing & Incentives
- Medicare Part D
- Pharmacy Guidelines
- Specialty Pharmaceuticals for Office Administration
- ProductsProducts
- Medicare Advantage Network Plans Overview
- Managed Care Plans
- PPO and Indemnity Products
- OMNIA Health Plans
- Horizon Medicare Blue Advantage (HMO)
- NJ SHBP/SEHBP Benefit Plans
- FEP
- Braven Health℠ Plans(Medicare Advantage)
- Recognition Programs and PartnershipsRecognition Programs and Partnerships
- Remote Patient Monitoring for COPD Provided by HGE Health
- Risk Adjustment OverviewRisk Adjustment Overview
- Self ServiceSelf Service
- Interactive Voice Response System (IVR) Interactive Voice Response System (IVR)
- Referral Process Using the Interactive Voice Response System
- Effective use of the Interactive Voice Response System
- Provider Online Services
- Surgical and Implantable Device Management ProgramSurgical and Implantable Device Management Program
- About the Surgical and Implantable Device Management Program
- Cardiac Services Cardiac Services
- Orthopedic Services Orthopedic Services
- Medical Policy Criteria and Guidelines
- PA/MND Process
- Using Out-of-Network Providers in Surgical Services
- Value-Based ProgramsValue-Based Programs
- HEDIS® Resources
- Claim Submission & BillingClaim Submission & Billing
- Claim Editing Policies
- Claim Reimbursement
- Claim Submission Claim Submission
- Electronic Claim Adjustments
- Explanation of Payment
- PCP Billable Lists
- Pre-payment Correct Coding Reviews
- Prompt Pay Guidelines
- Demographic UpdatesDemographic Updates
- The Importance of Demographic Updates
- Provider Directory Management Policy
- CMS Audits to Validate Directory Information
- Initiating Demographic Updates
- Inquiries, Complaints & AppealsInquiries, Complaints & Appeals
- Inquiries
- Complaints
- Time Limits for Filing Inquiries/Complaints
- Resolving Inquiries/Complaints
- Appeals of Non-Utilization Management Determinations
- Appeals of Utilization Management/Medical Management Determinations
- Appeals of Post Service Medical Necessity Determinations
- PoliciesPolicies
- Medical Policies Medical Policies
- Allied Health
- DME
- Drugs
- Introduction
- Medicine
- Obstetrics
- Pathology
- Radiology
- Surgery
- Treatment
- MCG Care Guidelines
- Documentation Submission Guidelines
- Administrative Policies Administrative Policies
- Allowable Practice Locations for Pathologists
- Appointment Availability Access Standards for Primary Care-Type Providers, ObGyns, Specialists and Behavioral Health Providers
- Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers
- Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals
- EDI and NaviNet Claims Submission Requirement
- Electronic Funds Transfer (EFT)
- Material Adverse Change (MAC) Notification Policy
- Medical Records Documentation Standards
- Medicare Advantage Readmission
- Never Events
- Out-of-Network Referral Policy
- Outlier Audit Programs: Post Payment and Pre-Payment
- Physician and Healthcare Professional Counseling and Termination Policy - Professional Competency
- Participation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon Network
- Practice Location Reinstatements
- Practice Locations Limit
- Practitioner Office Site Quality and Medical Record Keeping Standards
- Provider Directory Management
- Provider Outlier Program Frequently Asked Questions
- Retainer Based Medicine
- Standards for All Types of Medical and Dental Diagnostic Radiology and Imaging Facilities
- Tier Awareness Policy
- Use of Horizon Hospital Network Performance Data
- Use of Practitioner Performance Data
- BlueCard Medical Policies
- Reimbursement Policies & Guidelines Reimbursement Policies & Guidelines
- Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)
- After-hours and Weekend Care
- Ambulance Services
- Ambulatory Electrocardiographic Monitoring
- Anesthesia Reimbursement Guidelines
- ASC Multiple Procedure Methodology
- Assistant at Surgery
- Balloon Sinuplasty
- Bariatric Surgery Billed With Hiatal Hernia Repair
- Bilateral Procedures
- Billing Guidelines for Maternity Services
- Cardiac Event Detection
- Cardiovascular Implant Device Monitoring Services
- Casting, Strapping and Splints
- Chemotherapy Administration
- Chronic Care Management Services
- Claim Editing Policies
- Claims Requiring Additional Documentation
- ClaimsXten Editing Rules
- Clinical Trials Support Program
- Co-Surgeon Reimbursement
- Colonoscopy with Modifier 59
- Conscious Sedation
- Consultation Services Payment
- Consumable Medical Supplies
- Continuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) Supplies
- COVID 19 Antibody Testing
- Daily Management of Epidural or Subarachnoid Continuous Drug Administration
- Daily Maximum Units for Surgical Pathology and Microscopic Examination
- Determination of Refractive State
- Diabetic Screening Services
- Diabetic Supplies
- Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)
- DME Rent to Purchase
- Drug and Immunization Pricing
- Duplex Scanning
- Drug Wastage – Modifier JW
- Duplicate Claim Logic for Independent Laboratory Services
- Enhancement to CMS Always Bundled Edit
- Evaluation and Management Services with Chiropractic Manipulative Treatment
- Evaluation and Management Services with Osteopathic Manipulative Treatment
- Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion Imaging
- False Claims
- Frequency of Care Coordination Services and ESRD Procedures
- Frequency of G0179
- Hip Arthroscopy
- Hospital Non-Patient Laboratory Services Hospital Non-Patient Laboratory Services
- Hot or Cold Pack Therapy
- Inpatient Consultations
- Knee Arthroscopy
- Lab Panel Rebundling
- Laboratory Services Billed by Physicians
- Laser Treatment of Psoriasis or Parapsoriasis
- Maternity Reimbursement
- Maximum Units for Anesthesia
- Medical Nutrition Therapy (MNT)
- Microsurgery and Robotic Surgery
- Modifier 25
- Modifier 50 Bilateral Guidelines
- Modifier 52
- Modifier 53
- Modifier 54
- Modifier 55
- Modifier 56
- Modifier 57
- Modifier 76
- Modifier 77
- Modifier 78
- Modifier SU
- Multiple Procedure Reductions
- Mutually and Non-Mutually Exclusive NCCI Supplemental Edits
- Non-ESRD ESA Level Reporting
- Noncovered Related Services
- Outpatient Consultations
- Outpatient Laboratory Claims: Referring Practitioner Required
- Outpatient Therapy Daily Maximum
- Physician Extenders Non-Surgical Services
- Pre-Admission Testing
- Pre-Payment Documentation Requests: Facility Claims
- Post Payment Documentation Requests: Facility Claims
- Pulmonary Diagnostic Procedures when billed with E&M Codes
- Radiology, Preliminary and Double Reads
- Radiopharmaceuticals
- Reimbursement and Billing Guidelines for Anesthesia Claims
- Removal of Impacted Cerumen Requiring Instrumentation
- Screening and Diagnostic Mammography & 3D Tomosynthesis
- Site of Service Differential
- Smoking Cessation
- Status N Codes
- Telemedicine Services Telemedicine Services
- Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and products
- Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare Advantage
- Ulcer Debridement and Ulcer Stages
- Urinalysis with Evaluation and Management (E&M) Services
- Urine Drug Screening/Testing
- Vitamin D Testing
- Utilization ManagementUtilization Management
- Clinical Practice Guidelines
- PT/OT Outpatient Prior Authorization for Horizon Medicare Advantage Plans
- Services Requiring Prior Authorization Services Requiring Prior Authorization
- Prior Authorization Procedure Search Tool
- BlueCard Members
- FEP Members
- Medicare Advantage
- OMNIA Health Plans
- SHBP/SEHBP
- UNITE HERE HEALTH
- Utilization Management Request Tool
- Consumer Assessment of Healthcare Providers and Systems (CAHPS)Consumer Assessment of Healthcare Providers and Systems (CAHPS)
- Cultural Competency
- Educational WebinarsEducational Webinars
- Electronic ID CardsElectronic ID Cards
- HealthSphereHealthSphere
- Manuals & User GuidesManuals & User Guides
- Agreements
- Ancillary Manual
- Hospital Manual Hospital Manual
- Claims Submissions and Reimbursement
- Coordination of Benefits
- HIPAA
- Horizon Behavioral Health
- Identification
- Inquiries, Complaints and Appeals
- Patient Health Support
- Patient-Centered Programs
- Policies, Procedures and General Guidelines
- Products
- Programs Administered by eviCore healthcare
- Quality Management
- Quality Recognition Programs
- Service
- The BlueCard Program
- Utilization Management
- Participating Physician and Other Health Care Professional Office Manual Participating Physician and Other Health Care Professional Office Manual
- At Your Service
- The BlueCard Program
- Claims Submissions and Reimbursement
- Coordination of Benefits
- HIPAA
- Horizon Behavioral Health
- Horizon Hospital Network
- Identification
- Inquiries, Complaints and Appeals
- Member Rights and Responsibilities
- Patient-Centered Programs
- Patient Health Support
- Payment Summaries and Vouchers
- Policies, Procedures and General Guidelines
- Products
- Provider Responsibilities
- Quality Management
- Quality Recognition Programs
- Referrals
- Service
- Special Programs
- Utilization Management
- Welcome Kit Handbook
- Network Specialists
- Provider Self-Service ToolsProvider Self-Service Tools
- Quality Resource CenterQuality Resource Center
- TrainingTraining
- CMS Training Requirements CMS Training Requirements
- Education Education
- Forms by Plan TypeForms by Plan Type
- Forms by Specialty TypeForms by Specialty Type
- Horizon Behavioral Health
- Radiology Center Assessment Tool (RCAT)
- Radiology Professional Group Assessment Tool
- Reimbursement / Payment
- Forms by TypeForms by Type
- Appeal / Dispute
- Assess / Evaluate / Examine
- Authorizations
- Claim
- Consent
- Credentialing
- Electronic Transaction Forms
- Enroll / Elect / Apply
- Horizon NJ TotalCare (HMO D-SNP) Forms
- Inquiry / Request
- Prescription Drug Mail Order
- Frequently Used Forms
- Miscellaneous
- W9 Form-Dental
- W9 Form-Medical
- Blue Review
- News & Legal Notices
- Provider Alerts
- BlueCard Announcements
Alert
Toggle menu
- BACKback to www.horizonblue.com
- PROVIDERS
-
COVID-19 InformationCOVID-19 Information
- COVID-19 Information
- June 2021 Updates: COVID-19 treatment cost share waiverJune 2021 Updates: COVID-19 treatment cost share waiver
- Reminder: Use correct codes when evaluating for COVID-19Reminder: Use correct codes when evaluating for COVID-19
- Policy Update: Antibody Testing ClaimsPolicy Update: Antibody Testing Claims
- Update: Members’ cost sharing waived for treatment of COVID-19 through June 2021Update: Members’ cost sharing waived for treatment of COVID-19 through June 2021
- Submitting claims for COVID-19 vaccines delivered in non-traditional medical settingsSubmitting claims for COVID-19 vaccines delivered in non-traditional medical settings
- Every shot counts – keeping your patients informed about the COVID-19 vaccinesEvery shot counts – keeping your patients informed about the COVID-19 vaccines
- For Essential Workers, COVID-19 Treatment Covered Under Workers’ Compensation BenefitsFor Essential Workers, COVID-19 Treatment Covered Under Workers’ Compensation Benefits
- Submitting Pharmacy Claims for COVID-19 VaccinationsSubmitting Pharmacy Claims for COVID-19 Vaccinations
- Update: Prior Authorization Requirements for Inpatient Admissions and Post-Acute Facility Admissions to be ReinstatedUpdate: Prior Authorization Requirements for Inpatient Admissions and Post-Acute Facility Admissions to be Reinstated
- COVID-19 vaccine administration reimbursement at UCCsCOVID-19 vaccine administration reimbursement at UCCs
- COVID-19 vaccines available in Essex County – Information for your staff and patientsCOVID-19 vaccines available in Essex County – Information for your staff and patients
- Reimbursement Policy effective January 1, 2021: Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)Reimbursement Policy effective January 1, 2021: Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)
- COVID-19 vaccines will be covered at 100%COVID-19 vaccines will be covered at 100%
- Coverage for antibody infusion therapyCoverage for antibody infusion therapy
- Waiving Prior Authorization Requirements for Emergent In-Network Inpatient Admissions and Post-Acute Facility AdmissionsWaiving Prior Authorization Requirements for Emergent In-Network Inpatient Admissions and Post-Acute Facility Admissions
- Update: Antibody Testing ClaimsUpdate: Antibody Testing Claims
- Update: Cost-share waiver for telemedicine and COVID-19 testing extendedUpdate: Cost-share waiver for telemedicine and COVID-19 testing extended
- Cost Sharing on Claims with Multiple DiagnosesCost Sharing on Claims with Multiple Diagnoses
- Dates for Certain Prior Authorization Waivers Further ExtendedDates for Certain Prior Authorization Waivers Further Extended
- Dates for Prior Authorization Waivers ExtendedDates for Prior Authorization Waivers Extended
- New Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769New Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769
- COVID-19 Update: Medical Policy Revisions & ImplementationsCOVID-19 Update: Medical Policy Revisions & Implementations
- 72 Doctors, Nurses, Pharmacists and Health Clinicians from Horizon BCBSNJ Answer Governor Murphy’s “HealthCare Professionals Call to Serve”72 Doctors, Nurses, Pharmacists and Health Clinicians from Horizon BCBSNJ Answer Governor Murphy’s “HealthCare Professionals Call to Serve”
- New Jersey Pandemic Relief Fund Efforts Get $2 Million Boost from HorizonNew Jersey Pandemic Relief Fund Efforts Get $2 Million Boost from Horizon
- A special message from Howard A. Cutler, Vice President, Healthcare DeliveryA special message from Howard A. Cutler, Vice President, Healthcare Delivery
- Behavioral Health Continuity During the COVID-19 Public Health EmergencyBehavioral Health Continuity During the COVID-19 Public Health Emergency
- COVID-19 Frequently Asked QuestionsCOVID-19 Frequently Asked Questions
- Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility AdmissionsWaiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility Admissions
- Horizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health ProfessionalsHorizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health Professionals
- COVID-19 Update: Authorizations Waived for Oxygen Following ER DischargeCOVID-19 Update: Authorizations Waived for Oxygen Following ER Discharge
- Reminder to use specific codes when evaluating for COVID-19Reminder to use specific codes when evaluating for COVID-19
- COVID-19 Update: Telemedicine Reimbursement Policy AddendaCOVID-19 Update: Telemedicine Reimbursement Policy Addenda
- Provisionally Join Horizon BCBSNJ Network(s) to Assist with the COVID-19 PandemicProvisionally Join Horizon BCBSNJ Network(s) to Assist with the COVID-19 Pandemic
- Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissionsWaiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions
- Providing Telephonic care with no costs to membersProviding Telephonic care with no costs to members
- COVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine ServicesCOVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine Services
- COVID-19 CPT testing codesCOVID-19 CPT testing codes
- Eliminating Cost Sharing Related to COVID-19 Testing and EvaluationEliminating Cost Sharing Related to COVID-19 Testing and Evaluation
- Staying Informed: COVID-19 CoronavirusStaying Informed: COVID-19 Coronavirus
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Why JoinWhy Join
- Why Join
- Our CommitmentOur Commitment
-
Join Our NetworksJoin Our Networks
- Join Our Networks
- Join a Horizon BCBSNJ or Horizon NJ Health Network (Physicians and Other Healthcare Professionals )Join a Horizon BCBSNJ or Horizon NJ Health Network (Physicians and Other Healthcare Professionals )
- Join the Horizon BCBSNJ Network (Ancillary Providers)Join the Horizon BCBSNJ Network (Ancillary Providers)
- Join the Horizon NJ Health Network (Ancillary Providers)Join the Horizon NJ Health Network (Ancillary Providers)
- Join the Horizon Dental NetworkJoin the Horizon Dental Network
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Our Healthcare FacilitiesOur Healthcare Facilities
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Products & ProgramsProducts & Programs
- Products & Programs
-
AIM Specialty HealthAIM Specialty Health
- AIM Specialty Health
- Diagnostic Imaging ProgramDiagnostic Imaging Program
- Frequently Asked QuestionsFrequently Asked Questions
- Groups Enrolled With AIMGroups Enrolled With AIM
- Muskoskeletal ProgramMuskoskeletal Program
- Procedure Codes Reviewed by AIMProcedure Codes Reviewed by AIM
- Sleep Disorder Management ProgramSleep Disorder Management Program
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Braven HealthBraven Health
- Case ManagementCase Management
- Chronic Care ProgramChronic Care Program
-
BlueCard ProgramBlueCard Program
- BlueCard Program
- BlueCard AnnouncementsBlueCard Announcements
- BlueCard ClaimsBlueCard Claims
- BlueCard Medical Policy/Pre-Certification InfoBlueCard Medical Policy/Pre-Certification Info
- BlueCard Program FAQsBlueCard Program FAQs
- BlueCard Program OverviewBlueCard Program Overview
- BlueCard Program TutorialBlueCard Program Tutorial
- GeoBlue: International CoverageGeoBlue: International Coverage
- How to Identify BlueCard MembersHow to Identify BlueCard Members
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Dental ServicesDental Services
- EDI & EFT TransactionsEDI & EFT Transactions
-
eviCore Health CareeviCore Health Care
- eviCore Health Care
- Cardiology Imaging ProgramCardiology Imaging Program
- Molecular and Genomic Testing ProgramMolecular and Genomic Testing Program
- Musculoskeletal ProgramMusculoskeletal Program
- Radiation Therapy ProgramRadiation Therapy Program
- Radiology/Imaging ServicesRadiology/Imaging Services
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Horizon Behavioral Health℠Horizon Behavioral Health℠
- Horizon Care@HomeHorizon Care@Home
- Medical Injectables ProgramMedical Injectables Program
- Patient Health SupportPatient Health Support
- Pharmacy ProgramsPharmacy Programs
-
ProductsProducts
- Products
- Medicare Advantage Network Plans OverviewMedicare Advantage Network Plans Overview
- Managed Care PlansManaged Care Plans
- PPO and Indemnity ProductsPPO and Indemnity Products
- OMNIA Health PlansOMNIA Health Plans
- Horizon Medicare Blue Advantage (HMO)Horizon Medicare Blue Advantage (HMO)
- NJ SHBP/SEHBP Benefit PlansNJ SHBP/SEHBP Benefit Plans
- FEPFEP
- Braven Health℠ Plans(Medicare Advantage)Braven Health℠ Plans(Medicare Advantage)
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Recognition Programs and PartnershipsRecognition Programs and Partnerships
- Remote Patient Monitoring for COPD Provided by HGE HealthRemote Patient Monitoring for COPD Provided by HGE Health
- Risk Adjustment OverviewRisk Adjustment Overview
-
Self ServiceSelf Service
- Self Service
-
Interactive Voice Response System (IVR)Interactive Voice Response System (IVR)
- Interactive Voice Response System (IVR)
- Referral Process Using the Interactive Voice Response SystemReferral Process Using the Interactive Voice Response System
- Effective use of the Interactive Voice Response SystemEffective use of the Interactive Voice Response System
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Provider Online ServicesProvider Online Services
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Surgical and Implantable Device Management ProgramSurgical and Implantable Device Management Program
- Surgical and Implantable Device Management Program
- About the Surgical and Implantable Device Management ProgramAbout the Surgical and Implantable Device Management Program
-
Cardiac ServicesCardiac Services
- Cardiac Services
- Surgical and Implantable Device Management Program for Cardiac Surgeries Frequently Asked Questions Updated: March 25, 2021Surgical and Implantable Device Management Program for Cardiac Surgeries Frequently Asked Questions Updated: March 25, 2021
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Orthopedic ServicesOrthopedic Services
- Medical Policy Criteria and GuidelinesMedical Policy Criteria and Guidelines
- PA/MND ProcessPA/MND Process
- Using Out-of-Network Providers in Surgical ServicesUsing Out-of-Network Providers in Surgical Services
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Value-Based ProgramsValue-Based Programs
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Policies & ProceduresPolicies & Procedures
- Policies & Procedures
- HEDIS® ResourcesHEDIS® Resources
-
Claim Submission & BillingClaim Submission & Billing
- Claim Submission & Billing
- Claim Editing PoliciesClaim Editing Policies
- Claim ReimbursementClaim Reimbursement
- Claim SubmissionClaim Submission
- Electronic Claim AdjustmentsElectronic Claim Adjustments
- Explanation of PaymentExplanation of Payment
- PCP Billable ListsPCP Billable Lists
- Pre-payment Correct Coding ReviewsPre-payment Correct Coding Reviews
- Prompt Pay GuidelinesPrompt Pay Guidelines
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Demographic UpdatesDemographic Updates
- Demographic Updates
- The Importance of Demographic UpdatesThe Importance of Demographic Updates
- Provider Directory Management PolicyProvider Directory Management Policy
- CMS Audits to Validate Directory InformationCMS Audits to Validate Directory Information
- Initiating Demographic UpdatesInitiating Demographic Updates
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Inquiries, Complaints & AppealsInquiries, Complaints & Appeals
- Inquiries, Complaints & Appeals
- InquiriesInquiries
- ComplaintsComplaints
- Time Limits for Filing Inquiries/ComplaintsTime Limits for Filing Inquiries/Complaints
- Resolving Inquiries/ComplaintsResolving Inquiries/Complaints
- Appeals of Non-Utilization Management DeterminationsAppeals of Non-Utilization Management Determinations
- Appeals of Utilization Management/Medical Management DeterminationsAppeals of Utilization Management/Medical Management Determinations
- Appeals of Post Service Medical Necessity DeterminationsAppeals of Post Service Medical Necessity Determinations
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
PoliciesPolicies
- Policies
-
Medical PoliciesMedical Policies
- Medical Policies
- Allied HealthAllied Health
- DMEDME
- DrugsDrugs
- IntroductionIntroduction
- MedicineMedicine
- ObstetricsObstetrics
- PathologyPathology
- RadiologyRadiology
- SurgerySurgery
- TreatmentTreatment
- MCG Care GuidelinesMCG Care Guidelines
- Documentation Submission GuidelinesDocumentation Submission Guidelines
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Administrative PoliciesAdministrative Policies
- Administrative Policies
- Allowable Practice Locations for PathologistsAllowable Practice Locations for Pathologists
- Appointment Availability Access Standards for Primary Care-Type Providers, ObGyns, Specialists and Behavioral Health ProvidersAppointment Availability Access Standards for Primary Care-Type Providers, ObGyns, Specialists and Behavioral Health Providers
- Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) ProvidersCredentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers
- Credentialing and Recredentialing Policy for Participating Physicians and Healthcare ProfessionalsCredentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals
- EDI and NaviNet Claims Submission RequirementEDI and NaviNet Claims Submission Requirement
- Electronic Funds Transfer (EFT)Electronic Funds Transfer (EFT)
- Material Adverse Change (MAC) Notification PolicyMaterial Adverse Change (MAC) Notification Policy
- Medical Records Documentation StandardsMedical Records Documentation Standards
- Medicare Advantage ReadmissionMedicare Advantage Readmission
- Never EventsNever Events
- Out-of-Network Referral PolicyOut-of-Network Referral Policy
- Outlier Audit Programs: Post Payment and Pre-PaymentOutlier Audit Programs: Post Payment and Pre-Payment
- Physician and Healthcare Professional Counseling and Termination Policy - Professional CompetencyPhysician and Healthcare Professional Counseling and Termination Policy - Professional Competency
- Participation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon NetworkParticipation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon Network
- Practice Location ReinstatementsPractice Location Reinstatements
- Practice Locations LimitPractice Locations Limit
- Practitioner Office Site Quality and Medical Record Keeping StandardsPractitioner Office Site Quality and Medical Record Keeping Standards
- Provider Directory ManagementProvider Directory Management
- Provider Outlier Program Frequently Asked QuestionsProvider Outlier Program Frequently Asked Questions
- Retainer Based MedicineRetainer Based Medicine
- Standards for All Types of Medical and Dental Diagnostic Radiology and Imaging FacilitiesStandards for All Types of Medical and Dental Diagnostic Radiology and Imaging Facilities
- Tier Awareness PolicyTier Awareness Policy
- Use of Horizon Hospital Network Performance DataUse of Horizon Hospital Network Performance Data
- Use of Practitioner Performance DataUse of Practitioner Performance Data
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- BlueCard Medical PoliciesBlueCard Medical Policies
-
Reimbursement Policies & GuidelinesReimbursement Policies & Guidelines
- Reimbursement Policies & Guidelines
- Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)
- After-hours and Weekend CareAfter-hours and Weekend Care
- Ambulance ServicesAmbulance Services
- Ambulatory Electrocardiographic MonitoringAmbulatory Electrocardiographic Monitoring
- Anesthesia Reimbursement GuidelinesAnesthesia Reimbursement Guidelines
- ASC Multiple Procedure MethodologyASC Multiple Procedure Methodology
- Assistant at SurgeryAssistant at Surgery
- Balloon SinuplastyBalloon Sinuplasty
- Bariatric Surgery Billed With Hiatal Hernia RepairBariatric Surgery Billed With Hiatal Hernia Repair
- Bilateral ProceduresBilateral Procedures
- Billing Guidelines for Maternity ServicesBilling Guidelines for Maternity Services
- Cardiac Event DetectionCardiac Event Detection
- Cardiovascular Implant Device Monitoring ServicesCardiovascular Implant Device Monitoring Services
- Casting, Strapping and SplintsCasting, Strapping and Splints
- Chemotherapy AdministrationChemotherapy Administration
- Chronic Care Management ServicesChronic Care Management Services
- Claim Editing PoliciesClaim Editing Policies
- Claims Requiring Additional DocumentationClaims Requiring Additional Documentation
- ClaimsXten Editing RulesClaimsXten Editing Rules
- Clinical Trials Support ProgramClinical Trials Support Program
- Co-Surgeon ReimbursementCo-Surgeon Reimbursement
- Colonoscopy with Modifier 59Colonoscopy with Modifier 59
- Conscious SedationConscious Sedation
- Consultation Services PaymentConsultation Services Payment
- Consumable Medical SuppliesConsumable Medical Supplies
- Continuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) SuppliesContinuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) Supplies
- COVID 19 Antibody TestingCOVID 19 Antibody Testing
- Daily Management of Epidural or Subarachnoid Continuous Drug AdministrationDaily Management of Epidural or Subarachnoid Continuous Drug Administration
- Daily Maximum Units for Surgical Pathology and Microscopic ExaminationDaily Maximum Units for Surgical Pathology and Microscopic Examination
- Determination of Refractive StateDetermination of Refractive State
- Diabetic Screening ServicesDiabetic Screening Services
- Diabetic SuppliesDiabetic Supplies
- Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)
- DME Rent to PurchaseDME Rent to Purchase
- Drug and Immunization PricingDrug and Immunization Pricing
- Duplex ScanningDuplex Scanning
- Drug Wastage – Modifier JWDrug Wastage – Modifier JW
- Duplicate Claim Logic for Independent Laboratory ServicesDuplicate Claim Logic for Independent Laboratory Services
- Enhancement to CMS Always Bundled EditEnhancement to CMS Always Bundled Edit
- Evaluation and Management Services with Chiropractic Manipulative TreatmentEvaluation and Management Services with Chiropractic Manipulative Treatment
- Evaluation and Management Services with Osteopathic Manipulative TreatmentEvaluation and Management Services with Osteopathic Manipulative Treatment
- Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion ImagingEvaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion Imaging
- False ClaimsFalse Claims
- Frequency of Care Coordination Services and ESRD ProceduresFrequency of Care Coordination Services and ESRD Procedures
- Frequency of G0179Frequency of G0179
- Hip ArthroscopyHip Arthroscopy
- Hospital Non-Patient Laboratory ServicesHospital Non-Patient Laboratory Services
- Hot or Cold Pack TherapyHot or Cold Pack Therapy
- Inpatient ConsultationsInpatient Consultations
- Knee ArthroscopyKnee Arthroscopy
- Lab Panel RebundlingLab Panel Rebundling
- Laboratory Services Billed by PhysiciansLaboratory Services Billed by Physicians
- Laser Treatment of Psoriasis or ParapsoriasisLaser Treatment of Psoriasis or Parapsoriasis
- Maternity ReimbursementMaternity Reimbursement
- Maximum Units for AnesthesiaMaximum Units for Anesthesia
- Medical Nutrition Therapy (MNT)Medical Nutrition Therapy (MNT)
- Microsurgery and Robotic SurgeryMicrosurgery and Robotic Surgery
- Modifier 25Modifier 25
- Modifier 50 Bilateral GuidelinesModifier 50 Bilateral Guidelines
- Modifier 52Modifier 52
- Modifier 53Modifier 53
- Modifier 54Modifier 54
- Modifier 55Modifier 55
- Modifier 56Modifier 56
- Modifier 57Modifier 57
- Modifier 76Modifier 76
- Modifier 77Modifier 77
- Modifier 78Modifier 78
- Modifier SUModifier SU
- Multiple Procedure ReductionsMultiple Procedure Reductions
- Mutually and Non-Mutually Exclusive NCCI Supplemental EditsMutually and Non-Mutually Exclusive NCCI Supplemental Edits
- Non-ESRD ESA Level ReportingNon-ESRD ESA Level Reporting
- Noncovered Related ServicesNoncovered Related Services
- Outpatient ConsultationsOutpatient Consultations
- Outpatient Laboratory Claims: Referring Practitioner RequiredOutpatient Laboratory Claims: Referring Practitioner Required
- Outpatient Therapy Daily MaximumOutpatient Therapy Daily Maximum
- Physician Extenders Non-Surgical ServicesPhysician Extenders Non-Surgical Services
- Pre-Admission TestingPre-Admission Testing
- Pre-Payment Documentation Requests: Facility ClaimsPre-Payment Documentation Requests: Facility Claims
- Post Payment Documentation Requests: Facility ClaimsPost Payment Documentation Requests: Facility Claims
- Pulmonary Diagnostic Procedures when billed with E&M CodesPulmonary Diagnostic Procedures when billed with E&M Codes
- Radiology, Preliminary and Double ReadsRadiology, Preliminary and Double Reads
- RadiopharmaceuticalsRadiopharmaceuticals
- Reimbursement and Billing Guidelines for Anesthesia ClaimsReimbursement and Billing Guidelines for Anesthesia Claims
- Removal of Impacted Cerumen Requiring InstrumentationRemoval of Impacted Cerumen Requiring Instrumentation
- Screening and Diagnostic Mammography & 3D TomosynthesisScreening and Diagnostic Mammography & 3D Tomosynthesis
- Site of Service DifferentialSite of Service Differential
- Smoking CessationSmoking Cessation
- Status N CodesStatus N Codes
-
Telemedicine ServicesTelemedicine Services
- Telemedicine Services
- Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and productsTelemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and products
- Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare AdvantageTelemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare Advantage
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Ulcer Debridement and Ulcer StagesUlcer Debridement and Ulcer Stages
- Urinalysis with Evaluation and Management (E&M) ServicesUrinalysis with Evaluation and Management (E&M) Services
- Urine Drug Screening/TestingUrine Drug Screening/Testing
- Vitamin D TestingVitamin D Testing
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Utilization ManagementUtilization Management
- Utilization Management
- Clinical Practice GuidelinesClinical Practice Guidelines
- PT/OT Outpatient Prior Authorization for Horizon Medicare Advantage PlansPT/OT Outpatient Prior Authorization for Horizon Medicare Advantage Plans
-
Services Requiring Prior AuthorizationServices Requiring Prior Authorization
- Services Requiring Prior Authorization
- Prior Authorization Procedure Search ToolPrior Authorization Procedure Search Tool
- BlueCard MembersBlueCard Members
- FEP MembersFEP Members
- Medicare AdvantageMedicare Advantage
- OMNIA Health PlansOMNIA Health Plans
- SHBP/SEHBPSHBP/SEHBP
- UNITE HERE HEALTHUNITE HERE HEALTH
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Utilization Management Request ToolUtilization Management Request Tool
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
ResourcesResources
- Resources
- Consumer Assessment of Healthcare Providers and Systems (CAHPS)Consumer Assessment of Healthcare Providers and Systems (CAHPS)
- Cultural CompetencyCultural Competency
- Educational WebinarsEducational Webinars
- Electronic ID CardsElectronic ID Cards
- HealthSphereHealthSphere
-
Manuals & User GuidesManuals & User Guides
- Manuals & User Guides
- AgreementsAgreements
- Ancillary ManualAncillary Manual
-
Hospital ManualHospital Manual
- Hospital Manual
- Claims Submissions and ReimbursementClaims Submissions and Reimbursement
- Coordination of BenefitsCoordination of Benefits
- HIPAAHIPAA
- Horizon Behavioral HealthHorizon Behavioral Health
- IdentificationIdentification
- Inquiries, Complaints and AppealsInquiries, Complaints and Appeals
- Patient Health SupportPatient Health Support
- Patient-Centered ProgramsPatient-Centered Programs
- Policies, Procedures and General GuidelinesPolicies, Procedures and General Guidelines
- ProductsProducts
- Programs Administered by eviCore healthcarePrograms Administered by eviCore healthcare
- Quality ManagementQuality Management
- Quality Recognition ProgramsQuality Recognition Programs
- ServiceService
- The BlueCard ProgramThe BlueCard Program
- Utilization ManagementUtilization Management
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Participating Physician and Other Health Care Professional Office ManualParticipating Physician and Other Health Care Professional Office Manual
- Participating Physician and Other Health Care Professional Office Manual
- At Your ServiceAt Your Service
- The BlueCard ProgramThe BlueCard Program
- Claims Submissions and ReimbursementClaims Submissions and Reimbursement
- Coordination of BenefitsCoordination of Benefits
- HIPAAHIPAA
- Horizon Behavioral HealthHorizon Behavioral Health
- Horizon Hospital NetworkHorizon Hospital Network
- IdentificationIdentification
- Inquiries, Complaints and AppealsInquiries, Complaints and Appeals
- Member Rights and ResponsibilitiesMember Rights and Responsibilities
- Patient-Centered ProgramsPatient-Centered Programs
- Patient Health SupportPatient Health Support
- Payment Summaries and VouchersPayment Summaries and Vouchers
- Policies, Procedures and General GuidelinesPolicies, Procedures and General Guidelines
- ProductsProducts
- Provider ResponsibilitiesProvider Responsibilities
- Quality ManagementQuality Management
- Quality Recognition ProgramsQuality Recognition Programs
- ReferralsReferrals
- ServiceService
- Special ProgramsSpecial Programs
- Utilization ManagementUtilization Management
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Welcome Kit HandbookWelcome Kit Handbook
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Network SpecialistsNetwork Specialists
- Provider Self-Service ToolsProvider Self-Service Tools
- Quality Resource CenterQuality Resource Center
-
TrainingTraining
- Training
- CMS Training RequirementsCMS Training Requirements
-
EducationEducation
- Education
- ProductsProducts
- NavinetNavinet
-
Online ToolsOnline Tools
- Online Tools
- Electronic Funds TransferElectronic Funds Transfer
- Health Risk AssessmentHealth Risk Assessment
- Radiation Therapy Medical Necessity DeterminationRadiation Therapy Medical Necessity Determination
- Utilization Management Request ToolUtilization Management Request Tool
- Virtual ID CardsVirtual ID Cards
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
FormsForms
- Forms
- Forms by Plan TypeForms by Plan Type
-
Forms by Specialty TypeForms by Specialty Type
- Forms by Specialty Type
- Horizon Behavioral HealthHorizon Behavioral Health
- Radiology Center Assessment Tool (RCAT)Radiology Center Assessment Tool (RCAT)
- Radiology Professional Group Assessment ToolRadiology Professional Group Assessment Tool
- Reimbursement / PaymentReimbursement / Payment
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Forms by TypeForms by Type
- Forms by Type
- Appeal / DisputeAppeal / Dispute
- Assess / Evaluate / ExamineAssess / Evaluate / Examine
- AuthorizationsAuthorizations
- ClaimClaim
- ConsentConsent
- CredentialingCredentialing
- Electronic Transaction FormsElectronic Transaction Forms
- Enroll / Elect / ApplyEnroll / Elect / Apply
- Horizon NJ TotalCare (HMO D-SNP) FormsHorizon NJ TotalCare (HMO D-SNP) Forms
- Inquiry / RequestInquiry / Request
- Prescription Drug Mail OrderPrescription Drug Mail Order
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Frequently Used FormsFrequently Used Forms
- MiscellaneousMiscellaneous
- W9 Form-DentalW9 Form-Dental
- W9 Form-MedicalW9 Form-Medical
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- NewsNews
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN