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UNITE HERE HEALTH

Horizon BCBSNJ provides coverage to certain groups within UNITE HERE HEALTH (UHH), a multi-employer benefit trust fund serving the hospitality, food service and gaming industries.

Below is a list of the procedures/services that require prior authorization (PA) for members enrolled in the following UHH groups.

  • UHH Group # 76141 - Atlantic City
  • UHH Group # 76215 - New York
  • UHH Group # 76315 - New York
  • UHH Group #76275 - Food Service Plan 376
  • UHH Group #76305 - Food Service Plan 176
  • UHH Group #76306 - Food Service Plan 176
  • UHH Group #76307 - Food Service Plan 376

This list was revised on March 1, 2021, and may be subject to change.

  • Air Ambulance Transportation – NON-EMERGENT

  • Bariatric or Gastric Bypass Procedures – Surgery for Morbid Obesity, including but not limited to, Bariatric Procedures, Gastroplasty, Gastric Bypass - outpatient

  • Cardiac Radiology Services – non-emergent only Please note that only the following Cardiology Imaging Services require PA by eviCore healthcare for these members. (Visit the Cardiology Imaging Program webpage or call eviCore healthcare at 1-866-496-6200)
    • Stress testing (Myocardial perfusion imaging [SPECT and PET], Stress echocardiography)
    • Cardiac CT and MRI
    • Echocardiography: transthoracic and transesophageal
    • Diagnostic heart catheterization

  • Clinical Trials

  • Cosmetic Procedures and Potentially Cosmetic Procedures, including, but not limited to, cosmetic dermatology services, varicose vein procedures

  • Durable Medical Equipment (DME) - certain DME items costing over $500 (Visit the Horizon Care@Home webpage or call CareCentrix at 1-855-243-3321)

  • Gender Reassignment

  • Habilitative therapy for children with autism spectrum disorder (ABA therapy) (Call HealthCheck360 at 1-844-462-7812)

  • Home Health Care Services – all skilled services in the home

  • Home Hospice Services

  • Home Infusion Services (Visit the Horizon Care@Home webpage or call CareCentrix at 1-855-243-3321)

  • Hyberbaric Oxygen Therapy

  • Inpatient Admissions
    • Medical admissions
    • Surgical admissions
    • Hospice admissions (exclusive of maternity delivery)
    • Rehabilitation facility admissions (acute rehab, skilled nursing and sub-acute)
    • Mental health and substance abuse admissions (call Horizon Behavioral Health at 1-800-626-2212)

  • Medical Foods

  • Mental Health and Substance Abuse Services (call Horizon Behavioral Health at 1-800-626-2212)
    • Inpatient (IP)
    • Inpatient Detox
    • Residential (RTC)
    • 23hr Bed
    • 72hr Bed
    • Partial Hospitalization (PHP)
    • Intensive Outpatient (IOP)
    • Psychological Testing
    • In-Home Services
    • Electroconvulsive Therapy (ECT)
    • Transcranial Magnetic Stimulation (TMS)

  • Molecular and Genomic Testing services (Visit the Molecular and Genomic Testing Program webpage or call eviCore healthcare at 1-866-496-6200)

  • Prosthetics/Orthotics - over $500 (Visit the Horizon Care@Home webpage or call CareCentrix at 1-855-243-3321)

  • Radiation Therapy services (Visit the Radiation Therapy Program webpage or call eviCore healthcare at 1-866-242-5749)

  • Radiology/Imaging Services, including but not limited to the following. (Visit the Radiology/Imaging Services webpage or call eviCore healthcare at 1-866-496-6200)
    • Magnetic Resonance Imaging (MRI)
    • Magnetic Resonance Angiograms (MRAs)
    • Positron Emission Tomography (PET) scans
    • Positron Emission Tomography – Computed Tomography (PET-CT)
    • Computerized Tomography (CT) scans
    • Computed Tomography Angiography (CTA) scans
    • Nuclear Medicine
    • Nuclear Cardiac Imaging

  • Specialty Pharmaceuticals/Medical Injectable Drugs (e.g., Botox, IVIG, Flolan and derivatives, Xolair) (Visit the Medical Injectables Program webpage or call Magellan Rx Management at 1-800-424-4508)

  • Transplant Services, except Corneal Transplants (Case Management)

  • Travel and Lodging benefits (call UHH at 1-833-637-3519)