Horizon Behavioral Health
Applied Behavior Analysis (ABA) Authorization Request
Behavioral Health providers may use this form for both initial and concurrent requests for authorization of ABA services. ID: 40001
Applied Behavior Analysis (ABA) Service Area Information
Other Healthcare Professionals who provide ABA services should complete this form to help us understand the counties in which center-based and/or in-home ABA services can be provided. This information will help us provide accurate referrals for ABA services to our members in their preferred setting and geographic area. ID: 40096
Continuity of Practitioner Care
Behavioral Health providers may use this form to request continuity of practitioner care for patients enrolled in Horizon BCBSNJ plans.ID: H3154_6049
Authorization for Disclosure OR Request for Access to Protected Health Information (PHI)
Patients may use this form to authorize the use and disclosure private information (PI) held by Horizon BCBSNJ. ID: 32261
Psychological And Neuropsychological Assessment Supplemental Form
Behavioral Health providers may use this form to submit information to us pertaining to the assessment of patients. ID: 40002