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Horizon Behavioral Health

PDF  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

PDF  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

PDF  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

PDF  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

PDF  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