Case Management

Horizon BCBSNJ’s Case Management Program is a free, voluntary service that offers care coordination and guidance to our eligible members or their covered dependent(s) when faced with a serious illness or condition.

Our Care Managers work collaboratively with the member and his or her physician to develop a case management plan based on the treatment plan. The case management plan will consist of both short- and long-term goals for our members working to achieve self-management of an illness or condition.

Components of the Program

The Program provides eligible members with the education and guidance they may need when faced with complex medical situations.

Our full list of Complex Case Management trigger events and circumstances provides important information such as trigger diagnoses and Case Management ICD-10 codes.

Trained Care Managers, who are registered nurses, will work with you and your patient, our member, to provide the best possible outcomes and member experience.

Through the Program, our Care Managers:

• Regularly discuss the overall medical situation with you and your patient.
• Provide educational material, and information about the member, including information about your patient’s medical condition, to assist you in managing your patient’s health.
• Help your patient locate and coordinate appropriate care for his or her needs.
• Assist your patient in understanding how to maximize plan benefits and minimize out-of-pocket costs related to their condition(s).

For certain categories of Care Management, Horizon BCBSNJ offers Specialty Case Management Programs.

Referring Eligible Members

You can refer1 eligible Horizon BCBSNJ and Braven Health℠ members to the Case Management Program by:

• Completing the enrollment form; or
• Calling 1-888-621-5894 and selecting option 2. Representatives are available to help Monday through Friday, from 8 a.m. to 5 p.m., Eastern Time.

¹ You can also call the Member Services telephone number located on the back of the member ID card to find out if your patient is eligible for our Case Management Program.