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Prior Authorization Procedure Search Tool Enhancements

Horizon Blue Cross Blue Shield of New Jersey is pleased to announce the implementation of new capabilities within our Prior Authorization Procedure Search Tool. Now, it’s easier than ever for you to determine if services require prior authorization for your Horizon BCBSNJ patients.1

Prior Authorization Procedure Search Tool enhancements include:

  • A new user-friendly interface.
  • The ability to search for prior authorization information for your patients enrolled in:
    • - Commercial fully insured plans
    • - New Jersey State Health Benefits Program (SHBP) plans (excluding NJ DIRECT plans)
  • The ability to search for prior authorization information for up to five CPT® or HCPCS codes. Previously, searches were limited to one code at a time.
  • Printing capabilities from the search results page.

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

How to identify your patient’s health plan

Fully insured members have the following statement printed on the back of their member ID card, “Insured by Horizon BCBSNJ.”

State Health Benefits Program (SHBP) Horizon HMO members’ ID prefix starts with SNJ. In addition, the following statement is printed on the back of the member’s ID card, “Horizon BCBSNJ provides administrative services only and does not assume any financial risk for claims.”

For more information, select Fully Insured or SHBP HMO (NJ Direct Excluded) from the Select a line of business drop down menu on the Prior Authorization Search page.

Need help?

If you have questions, please contact your assigned Network Specialist by calling our Network Relations team at 1-800-624-1110. At the prompt, select More Options and then select Network Relations.

1 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 of a conflict between the information provided by the tool and member plan documents, member plan documents shall prevail.

This tool is provided 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: March 28, 2018, 01:28 a.m. ET
Last updated on: April 28, 2021, 05:48 a.m. ET