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Digital Member ID Card Policy

Administrative Policy:
Digital Member ID Card Policy

Effective Date:
January 1, 2022

Scope:
The guidelines of this policy apply to members enrolled in plans offered by Horizon Healthcare of New Jersey, Inc. and Horizon Healthcare Services, Inc. (collectively "Horizon") across their respective lines of business (HMO, POS, EPO, Qualified Health Plans, Direct Access, Medicare Advantage [including Braven Health℠] and Part D, PPO, Indemnity), as well as SHBP and SEHBP and other self-funded accounts that elect to participate in one or more Healthcare Management Programs, including but not limited to Network Management, Utilization Management, Pharmacy Management, Care Management, and Quality Management.

This guidelines of this policy do not apply to members enrolled in Horizon NJ Health plans.

Purpose:
Require providers to accept Digital Member ID card as proof of coverage. Require providers to electronically verify eligibility and coverage through NaviNet. Providers may not require that a member present a physical ID card as proof of coverage.

Policy:
Providers are required to accept Digital ID cards as valid proof of coverage. Providers may not refuse to provide services to a patient if a traditional, physical ID card is not presented. Digital member ID cards provide a secure way to access the most up-to-date member benefit information when patients present for care.

Providers can also verify eligibility through NaviNet as noted below.

  • Providers may access a Digital ID card image through NaviNet Eligibility and Benefits capability. A Digital ID card image includes the same information that would be included on a traditional, physical ID card.
  • Providers can also use our Eligibility and Benefits Cost Share Estimator on NaviNet to access estimated claim-level member eligibility, benefits and out-of-pocket costs. With this tool, providers no longer have to rely on printed member ID cards to confirm patients’ eligibility and benefit information.

If additional information is needed, providers can also call 1-800-624-1110.

Horizon members are able to access Digital ID card images by:

  • Signing in to the Horizon Blue app from a smart device and accessing their Digital ID card. Members can use the app to email or text a copy of their Digital ID card to a provider office.
  • Signing in on HorizonBlue.com. Here patients can print their Digital ID card image that can then be shared with provider offices.

Definitions:
Digital ID Card – An electronic ID card available through the Horizon Blue App, HorizonBlue.com or through NaviNet. Digital ID cards include the same detail and information that would be included on a traditional physical ID card.

Eligibility and Benefits Cost Share Estimator Tool – Gives access to current medical and behavioral health claim-level member eligibility, estimated benefits and out-of-pocket costs. This tool, available to all providers who are registered with NaviNet, provides information about patients enrolled in our Commercial and Medicare Advantage (including Braven Health℠) plans with a member ID number that includes “3HZN”.

Sanctions:
Providers that refuse to provide treatment to members who do not present a traditional physical ID card will be addressed in a manner consistent with contractual rights and remedies, including, but not limited to, termination with cause from our network(s). Horizon will continue to work with providers to provide education about Digital Member ID cards and help ensure that they have up-to-date information.

Exceptions:
No exceptions are permitted.

HCM-PP-HCS-031-1221