Initiating Demographic Updates: Nonparticipating Providers

We include the demographic information of many providers that do not participate in our networks within our provider files to help us appropriately process claims submitted for services provided to our members enrolled in plans that include out-of-network benefits.

To establish or update the information we have on file, out-of-network providers should complete and submit our Nonparticipating Provider Demographic Information form.

• Include a copy of your W-9 if your tax identification number is not already in our files.

Submitting this form does not change your nonparticipating status with Horizon, Braven Health℠ or Horizon NJ Health plans. Submitted claims will continue to be processed at our member’s out-of-network level of benefits.

To join a Horizon or Horizon NJ Health Network, please visit HorizonBlue.com/WhyJoin.