Reimbursement / Payment

 Election Form - Installment Payments for Maternity Services

Participating and non-participating obstetrical providers use this form to request payment on an installment basis for maternity services rendered during the term of a covered Horizon BCBSNJ member’s pregnancy. ID: 7145

 Request Form - Adjustment to Capitation for Multiple People

Use this form to request that Horizon BCBSNJ adjust capitation for multiple people. ID: 2801

 Request Form - Adjustment to Capitation for One Person

Use this form to request that Horizon BCBSNJ adjust capitation for one person. ID: 20002