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Prior Authorization Procedure Search Tool Available

Horizon Blue Cross Blue Shield of New Jersey is pleased to announce a new online tool that helps make it easier for you to determine if services require prior authorization for your fully insured Horizon BCBSNJ patients.*

Our Prior Authorization Procedure Search tool allows you to enter a CPT® or HCPCS code and select a place of service (e.g., inpatient, outpatient, office, home) to determine if the particular service provided in the selected service setting requires a prior authorization.

Access the Prior Authorization Procedure Search tool here or through links on the Horizon BCBSNJ plan central page of NaviNet®.

The tool, as well as certain prior authorization lists for ASO member groups, is accessible on the  Prior Authorization page of HorizonBlue.com.

To determine if a patient is fully insured or part of an ASO member group, please refer to the back of the member’s ID card.

  • Fully insured members’ cards will state: “Insured by Horizon Blue Cross Blue Shield of New Jersey.”
  • ASO members’ cards will state: “Horizon Blue Cross Blue Shield of New Jersey provides administrative services only and does not assume financial risk for claims.”

For more information, or if you have questions, please contact your Network Specialist.

*Our Prior Authorization Procedure Search Tool presently will only display results for insured Horizon BCBSNJ plans. Prior authorization information for members enrolled in self-insured, Administrative Services Only (ASO) plans, Medicare or Medicaid products cannot be accessed through this tool.

The information provided by this tool is not intended to replace or modify the terms, conditions limitations and exclusions contained within health benefit plans issued or administered by Horizon BCBSNJ. In the event a conflict between the information contained on the tool and member plan documents, member plan documents shall prevail.

This application is intended for informational purposes only. The results provided by this tool are not a guarantee of payment. Claim processing is subject to member eligibility and all member and group benefit limitations, conditions and exclusions.

CPT® is a registered trademark of the American Medical Association.

NaviNet® is a registered trademark of NaviNet, Inc.

Published on: April 4, 2016, 11:00 a.m. ET
Last updated on: February 3, 2017, 02:01 a.m. ET