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Prior Authorization Procedure Search Tool Now Available for Horizon Medicare Advantage and Braven Health℠ Plans

We're pleased to announce that you can now also use our Prior Authorization Procedure Search Tool to determine if services require prior authorization (PA) for your patients enrolled in Horizon Medicare Advantage, Braven Health, Horizon NJ Health and Horizon NJ TotalCare (HMO D-SNP) plans.

Simply enter a CPT® or HCPCS code to see if that service requires PA in a variety of settings.

You can access our Prior Authorization Procedure Search Tool directly from the links on the NaviNet® Horizon NJ Health plan central page or the Horizon BCBSNJ plan central page, or online at HorizonBlue.com/priorauthtool.

Did You Know?

  • The tool allows you to access the most up-to-date PA information for your patients enrolled in Horizon Medicare Advantage, Braven Health, Horizon commercial plans and SHBP/SEHBP employer groups, as well as Horizon NJ Health and Horizon NJ TotalCare (HMO D-SNP) plans without having to change websites.

  • This tool replaces all previously published lists or information we have made available to you about PA for impacted patients. Please refer to this tool as your “source-of-truth” for PA information.

  • You can access this tool on NaviNet from either the Horizon BCBSNJ or Horizon NJ Health plan pages and get PA information for both your Horizon and your Horizon NJ Health patients without having to change websites.

If you have questions, please contact your Network Specialist.

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. 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: June 20, 2022, 04:21 a.m. ET
Last updated on: June 16, 2022, 13:11 p.m. ET