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Update: Prior Authorization Procedure Search Tool now includes NJ DIRECT

It’s easy to find out if services for your Horizon BCBSNJ patients require prior authorization. Use our Prior Authorization Procedure Search Tool¹ to search for prior authorization information for your patients enrolled in:

  • Commercial fully insured plans
  • New Jersey State Health Benefits Program (SHBP) / School Employees’ Health Benefits Program (SEHBP) Horizon HMO plans
  • NJ DIRECT plans (new)

Access the Prior Authorization Procedure Search tool here or on 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.”

SHBP and SEHBP Horizon HMO members’ ID numbers begin with SNJ.

NJ DIRECT plan members’ ID number begin with NJX.

Need help?
If you have questions, please call your Network Specialist at 1-800-624-1110. At the prompt, select More Options and then select Network Relations.

¹The 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. If there is 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: January 23, 2020, 01:04 a.m. ET
Last updated on: April 28, 2021, 04:09 a.m. ET