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COVID-19

Cardiology Imaging Program

Horizon Blue Cross Blue Shield of New Jersey has partnered with eviCore healthcare to administer our Cardiology Imaging program by using evidence-based criteria and ensuring requests for advanced cardiac imaging meet quality standards recommended by organizations such as the American College of Cardiology, the American Heart Association and the Heart Rhythm Society and identifying the most appropriate cardiac imaging study based on the patient's medical and prior imaging history.

Please note that eligibility and participation may vary based on line of business therefore, all providers should check eligibility and benefits prior to performing any services related to this program. In addition, actual benefit determinations cannot be made until a claim is received and is subject to the provisions of the patient's present contract including any applicable deductible, coinsurance and/or coordination of benefits. Payment is dependent on the patient being an eligible Horizon BCBSNJ member at the time the services are rendered. Authorizations will be affected should the claim submitted differ from the information provided at the time of a request.

PA/MND REVIEW FOR OUT-OF-NETWORK SITES/FACILITIES

As part of this program eviCore also performs PA/MND reviews for services that are to be performed at facilities/sites that DO NOT participate with Horizon if:

  • The nonparticipating facility/site is physically located within New Jersey
  • Services are to be provided to patients enrolled in a Horizon or Braven Health plan that includes out-of-network benefits.

Members that do not have out-of-network benefits will continue to be directed to coordinate care at participating sites within Horizon's networks.

RESOURCES

ANNOUNCEMENTS / UPDATES

FIRST LEVEL UTILIZATION MANAGEMENT (UM) APPEALS

  • Fax first level UM appeals for Horizon Medicare Advantage and Braven Health Medicare Advantage members to 1-609-583-3028 or mail to:

    Braven Health Medical Appeals
    PO Box 10195
    Newark, NJ 07101
    Horizon Medicare Advantage Medical Appeals
    PO Box 10195
    Newark, NJ 07101
  • Fax first level UM appeals for Horizon fully insured commercial and ASO members to 1-866-699-8128 or mail to:

    eviCore healthcare
    Attn: Clinical Appeals Mail Stop 600
    400 Buckwalter Place Blvd
    Bluffton, SC 29910

eviCore healthcare also manages Cardiology Imaging services provided to members enrolled in Horizon NJ Health plans and programs (including Medicaid Managed Care, NJ FamilyCare, Horizon NJ TotalCare (HMO D-SNP) and Managed Long Term Services & Supports (MLTSS). Visit the Horizon NJ Health eviCore healthcare webpage for information.

eviCore healthcare is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey in the provision of Prior Authorization and/or Medical Necessity Review (PA/MND) of certain nonemergency radiology services.