Horizon Behavioral Health℠
Important Notice: 2020 Management Changes
As of March 30, 2020, Horizon BCBSNJ has completed the transition of the management of all administrative and clinical management of the Horizon Behavioral Health program – behavioral health services and benefits to our internal operations.
Prior announcements regarding this change are accessible on our News & Legal Notices webpage.
Below is important information and links to key resources to help behavioral health professionals manage the day-to-day relationship with us.
Behavioral Health Provider Resources
The Horizon Behavioral Health program ensures behavioral health services, including mental health/substance use disorder treatment, are available to help members better manage all parts of their health. We are focused on making sure our members get the right care when they need it.
Dedicated support 24/7
Horizon Behavioral Health is available 24 hours a day, seven days a week. If you or your eligible patients have questions about behavioral health member benefits and program support and services, call 1-800-626-2212.
Horizon Behavioral Health includes case management and utilization management programs. Our autism care management program provides a dedicated team and resources that reinforce the comprehensive care approach and puts the entire family at the center of care to help ensure each family member receives the support he or she needs.
Providers can call Horizon Behavioral Health Care Management at:
1-800-626-2212
1-800-991-5579 (for the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP) Program only)
If there is a request for a referral and/or information about providers in the member’s location, Behavioral Health Clinicians may conduct a brief screening to evaluate whether there is a need for urgent or emergent care. Referrals are made to participating providers, while considering member preferences such as geographic location, hours of service, cultural or language requirements, ethnicity, type of degree the provider holds and gender. Additionally, the member may require a clinician with a specialty such as treatment of eating disorders. In all cases, where available, the clinicians will assist in arranging care for the member. The name, location and phone number of at least three participating providers will be given to the member.
All behavioral health claims should be submitted electronically to Horizon BCBSNJ via our online Utilization Management Request Tool accessed on NaviNet® according to the Horizon BCBSNJ electronic claims processing procedures for professionals and ancillaries.
Acute care facilities should submit through clearinghouses only.
Horizon BCBSNJ Electronic Payor ID is 22099
Claims Inquiries:
1-800-624-1110
or
1-800-626-2212
1-800-991-5579 (for the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP) Program only)
If you need to mail claims:
Horizon BCBSNJ
Horizon Behavioral Health
PO Box 10191
Newark, NJ 07101-3189
Claims for Federal Employee Program® (FEP®) Members:
Horizon BCBSNJ
Horizon Behavioral Health
PO Box 656
Newark, NJ 07101-0656
Claims for BlueCard® Members:
Horizon BCBSNJ
Horizon Behavioral Health
PO Box 1301
Neptune, NJ 07754-1301
Horizon BCBSNJ uses MCG Health’s Care Guidelines (MCG) to make behavioral health care coverage determinations for members enrolled in all Horizon BCBSNJ plans.
American Society of Addiction Medicine (ASAM) criteria is used when making coverage determinations for services related Substance Use Disorders.
Horizon BCBSNJ does not require you to have a license to access the MCG Care Guidelines. When the MCG Care Guidelines are used to support an adverse medical necessity determination, the clinical rationale for the determination(s) will be included in the adverse determination letter from Horizon BCBSNJ. Upon request, we will provide the MCG Care Guidelines used in making the specific determination.
To register for NaviNet, visit NaviNet.net and click Sign Up under Getting Started with NaviNet.
All participating physicians and health care professionals are required to register for NaviNet within 30 days of your effective date of participation.
Through NaviNet, a multi-payer web portal, your office has access to the important Horizon BCBSNJ information (eligibility, benefits, claims status, online Explanations of Payments, submit and check status of UM authorization requests, etc.) that you need to conduct business with us on a day-to-day basis.
By using NaviNet, your office will have access to Horizon BCBSNJ information, as well as the information of many other New Jersey health plans.
To learn more about NaviNet, visit NaviNet.net and select Horizon BCBSNJ from the My Health Plans menu.
• Mouse over References and Resources and select Provider Reference Materials.
• Mouse over Resources and select Training, then Education.
• Select NaviNet Information Demo.
Horizon BCBSNJ manages the recredentialing of behavioral health practitioners and facilities for providers who are due to be recredentialed.
Please visit our Administrative Policies webpage to review policies related to recredentialing.
To contact the Horizon Behavioral Health team regarding service related issues (claims, appeals, benefit information, etc.) call:
1-800-626-2212
1-800-991-5579 (for the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP) Program only)
