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Credentialing Forms Have Been Updated

We’ve changed the initial credentialing forms that must be completed by practitioners who want to join one of our networks. This update will help improve the participation application process and ensures that we capture the right information. Please stop using any old credentialing forms and use the most current credentialing form versions.

  • Special Needs Form
    Providers who want to join our network(s) must complete a Special Needs form according to their provider type. This information helps us understand a practitioner’s experience treating patients with special needs so we can make clinically appropriate referrals for our members. There is one form for behavioral health practitioners and another for all other medical practitioners.
  • MAT/OBAT and Navigator Attestation
    Practitioners that provide Medication Assisted Treatment (MAT) or Office-Based Addiction Treatment (OBAT) services as part of their practice must complete this form. By completing this form, a practitioner attests that they (and their practice) comply with all requirements/guidelines established by the NJ Division of Medical Assistance and Health Services and the Division of Mental Health and Addiction Services in regard to providing MAT or OBAT to patients that have an addiction diagnosis.
  • Telemedicine-Only Application
    Nonparticipating practitioners seeking to join our network(s) who will ONLY provide telemedicine services to their Horizon BCBSNJ or Horizon NJ Health patients need to submit the new, streamlined participation application for telemedicine services.

Visit Join Our Networks for more information.

To participate with Horizon NJ Health, practitioners must be licensed and located within New Jersey. To participate with Horizon BCBSNJ, practitioners must be licensed in New Jersey, Delaware, New York or Pennsylvania and have a physical location in one of the counties within our local service area. Our local service area includes: all counties within NJ; Kent, New Castle or Sussex County, DE; Bronx, Kings, New York, Orange, Richmond, Rockland or Westchester County, NY; Bucks, Delaware, Monroe, Northampton, Philadelphia, Lehigh or Pike County, PA.

Published on: June 14, 2021, 00:31 a.m. ET
Last updated on: June 14, 2021, 16:55 p.m. ET