New UNITE HERE HEALTH Groups Effective June 1
Horizon BCBSNJ is pleased to advise that we now provide health insurance coverage to Food Service Plan (FSP) 176 and Food Service Plan (FSP) 376 within UNITE HERE HEALTH (UHH), a multi-employer benefit trust fund serving the hospitality, food service and gaming industries.
Effective June 1, 2020, these groups (previously enrolled in plans provided by Blue Cross Blue Shield of Illinois) are enrolled in the Horizon BCBSNJ plans noted below.
|Group Name||Group #||Horizon BCBSNJ plan||ID Card Prefix|
|Food Service Plan 176||76305||Horizon Direct Access||F5Z|
|Food Service Plan 176||76306||Horizon PPO||H7B|
|Food Service Plan 376||76275||Horizon Direct Access||F4S|
|Food Service Plan 376||76307||Horizon PPO||H7P|
Members who live outside of New Jersey are enrolled in Horizon PPO plans and access their network benefits when they visit providers participating in our broad Horizon PPO Network. Members who live in New Jersey are enrolled in Horizon Direct Access plans and may (but are not required to) choose a Primary Care Physician (PCP) to coordinate his or her care. Both plans include coverage outside our local service area through the BlueCard® PPO program.
For information about UNITE HERE HEALTH member benefits, please access the Benefits & Eligibility tool within NaviNet or call Physician Services at 1-800-624-1110 or our Centralized Service Center at 1-888-666-2535.
PRIOR AUTHORIZATION LISTS
The prior authorization requirements for these new UHH groups (76305, 76306, 76275 and 76307) vary from our other enrolled UHH groups.
To access the list of services/procedures that require prior authorization for these new UHH members, please visit Services Requiring Prior Authorization, select click UNITE HERE HEALTH and select the appropriate UHH group.
We encourage all providers to review this information to ensure that prior authorization is obtained where necessary to avoid delays in claim processing.
- Medical Cost Management Corporation (1-800-367-9938) performs PA for habilitative therapy for children with autism spectrum disorder (ABA therapy).
SUBMITTING PRIOR AUTHORIZATION REQUESTS
Most prior authorization requests can be submitted online. Simply log into NaviNet.net, access our Plan Central page and select Referrals and Authorization, then Utilization Management Requests.
As noted on the online PA list, certain services to be provided to FSP 376 & FSP 176 members require prior authorization through business partners working on our behalf, including:
eviCore healthcare performs PA for the following services as part of our existing programs
- Cardiology Imaging Program
- Molecular and Genomic Testing Program
- Radiation Therapy Program
- Radiology/Imaging Program
CareCentrix performs PA for the following services as part of our Horizon Care@Home program.
- Durable Medical Equipment (DME), Home Health Care Services, Home Hospice Services, Home Infusion Services, Prosthetics/Orthotics, Medical Foods
Medical Cost Management Corporation performs PA for habilitative therapy for children with autism spectrum
disorder (ABA therapy).
Magellan Rx Management performs PA for Specialty Pharmaceuticals/Medical Injectable Drugs through
our Medical Injectables Program