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)