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Horizon Data Submission Template for Ancillary Providers

You can use the submission template to update your phone, fax, email address(es) and billing information as well as meet the requirements to validate your data in our systems. Plus, the information that is displayed on the Horizon and Horizon NJ Health directories will be updated faster.

Use the Horizon Data Submission Template for Ancillary Providers to update:

  • Phone Number(s)
  • Email address(es)
  • Fax Number(s)
  • Billing Information


  1. Request a blank template

  2. You will need a blank template to make changes to your data.

  3. Establish a secure (encrypted) connection with us

  4. After we receive your request, we will email you a blank template and information to help you submit the template to us.

    The email you will receive back from Horizon will be using Horizon's Secure Blue encryption protocol which has created a secure connection between Horizon and you with the reply email.

    • Secure Blue is Horizon's encryption protocol which ensures the data included in the email cannot be read by anyone other than those on the distribution list of the email.

    • To maintain the secure connection, please send us your completed template by replying to the email that included the blank template.

    • The Secure Blue Connection will expire after 10 days of Horizon sending you the template.

    • If you reply after the 10 days, you will need to request another template to establish another secure connection or use one of the other acceptable secure (encrypted) channels: Transport Layer Security (TLS), Zix.

  5. Enter your data in the template

You will need to input your data for all the mandatory fields before you send us back the template.