Horizon Blue Cross Blue Shield of New Jersey has implemented specialty programs designed to ensure appropriateness in care and quality standards and is partnered with eviCore healthcare to manage our Radiology, Cardiology, Pain Management and Radiation Therapy programs.
Each program has its own page which includes all pertinent information. We encourage all providers to routinely view the program pages to ensure they have up-to-date and current information.
Please note that eligibility and participation may vary based on line of business therefore, all providers should check the eviCore healthcare website for eligibility prior to performing any services related to the program. In addition, actual benefit determinations cannot be made until the claim is received and will be 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 incurred. Authorizations will be affected should the claim submitted differ from the information provided at the time of this request.
For more information about eviCore healthcare and the programs administered, please click the following links.