Clinical Laboratory Services
Horizon BCBSNJ has participating agreements with a number of clinical laboratories that are able to provide general clinical laboratory testing as well as a variety of specialized and/or proprietary laboratory services to your patients.
- LabCorp and Quest Diagnostics are the preferred national clinical laboratory choices for your patients enrolled in plans that use the Horizon Managed Care Network.
Plans that use the Horizon Managed Care Network include but are not limited to Horizon HMO, Horizon Advantage EPO, OMNIA℠ Health Plans, Horizon Direct Access, Horizon POS, Horizon Medicare Advantage or NJ DIRECT plans.¹
LabCorp, Quest Diagnostics and BioReference Laboratories are the preferred national clinical laboratory choices for your patients enrolled in plans that use the Horizon PPO Network.
Plans that use the Horizon PPO Network include but are not limited to Horizon PPO, Indemnity, Horizon MyWay® and Federal Employee Program® [FEP®] plans).
Please search our Doctor & Hospital Finder on line to locate all participating clinical laboratories for your Horizon BCBSNJ patients.
FOR CLINICAL LABORATORY SERVICES THAT CAN BE PERFORMED IN NETWORK
Participating practitioners are encouraged to refer their Horizon BCBSNJ patients to preferred national clinical laboratories whenever possible.
Participating practitioners are required to refer their Horizon BCBSNJ patients enrolled in plans that do not include out-of-network benefits to participating clinical laboratories.
Participating practitioners are expected to refer their Horizon BCBSNJ patients enrolled in plans that include out-of-network benefits (or forward their testing samples) to participating clinical laboratories, whenever possible.
Participating practitioners must comply with the guidelines of our Out of Network Referral Policy² When referring such a patient or forwarding his/her sample to a non-participating clinical laboratory.
Participating practitioners are strongly encouraged to visit the websites of our participating clinical labs to review their test menus/directories to understand which laboratory services are available.
- Visit LabCorp.com and click Test Menu to review their complete test menu.
- Visit QuestDiagnostics.com, select the For Physicians & Hospitals tab, and click Test Directory to review their complete test menu.
- Visit BioReference.com, select Physicians, then click Test Directory to review their complete test menu.
FOR CLINICAL LABORATORY SERVICES THAT CANNOT BE PERFORMED IN NETWORK
There may be certain clinical laboratory services that are not performed by LabCorp, Quest Diagnostics, BioReference Laboratories or other participating clinical laboratory services providers.
- Please call 1-800-664-2583 to obtain Prior Authorization before referring a patient or forwarding a sample to a non-participating clinical laboratory for services that cannot be provided by LabCorp, Quest Diagnostics, BioReference or another clinical laboratory participating with your patient’s plan.
- If you do not obtain Prior Authorization, non-participating clinical laboratory claims will NOT be considered at your patients’ in-network level of benefits:
- Claims will be processed at the out-of-network level of benefits for your patients enrolled in plans that include OON benefits (as such, higher member cost sharing may apply to those OON claims)
- Claims will be denied for your patients enrolled in plans with no OON benefits.
¹ Pathology services provided in a hospital setting to members enrolled in Horizon BCBSNJ managed care plans by a practice that participates in the Horizon Managed Care Network are allowed as an exception to the above-described LabCorp/Quest Diagnostics network use requirements.
² To review our Out-of-Network Referral Policy, please log in to NaviNet and from the Horizon BCBSNJ plan central page:
- Mouse over References and Resources and click Provider Reference Materials
- Mouse over Policies and Procedures and click Policies
- Click Administrative Policies and then click Out-of-Network Referral Policy
LabCorp is the commonly used name for Corporation of America Holdings®. Laboratory Corporation of America® is a registered mark of Laboratory Corporation of America Holdings.
Quest Diagnostics is a registered trademark of Quest Diagnostics Incorporated.
BioReference Laboratories is a wholly owned subsidiary of Opko Health, Inc.
BioReference Laboratories, LabCorp and Quest Diagnostics are independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.
Federal Employee Program® and FEP® names are registered marks of the Blue Cross and Blue Shield Association. NJ DIRECT is administered by Horizon Blue Cross Blue Shield of New Jersey, an independent licensee of the Blue Cross and Blue Shield Association. OMNIA℠ and Horizon MyWay are service marks of Horizon Blue Cross Blue Shield of New Jersey.