Prior Authorization/Pre-Service Registration
CareCentrix is responsible for ensuring certain Horizon Care@Home services are medically necessary and appropriate through its utilization management activities, including:
- Durable medical equipment (including medical foods [enteral], and diabetic and other medical supplies)
- Orthotics and prosthetics
- Home infusion therapy
- Diabetic and other medical supplies
For home health services (including in-home nursing services, physical therapy, occupational therapy and speech therapy), you must obtain prior authorization using Horizon BCBSNJ's online utilization management request tool via NaviNet.
Rendering Providers
Participating Horizon Care@Home ancillary services providers of home care services are required to complete a pre-service registration for certain services, including:
- Durable medical equipment (including medical foods [enteral], and diabetic and other medical supplies)
- Orthotics and prosthetics
- Home infusion therapy
- Diabetic and other medical supplies
Registrations can easily be submitted by calling CareCentrix at 1-855-243-3324 between 8 a.m. and 6 p.m., Eastern Time. When you refer a patient to a participating Horizon Care@Home ancillary services provider, that rendering provider will work with CareCentrix to ensure that the appropriate prior authorization/pre-service registration is performed.
Referring/Ordering Providers
Physicians, other health care professionals, hospital discharge planners and case managers may initiate a prior authorization/pre-service registration by calling CareCentrix at 1-855-243-3321 between 8 a.m. and 6 p.m. (ET) for:
- Durable medical equipment (including medical foods [enteral], and diabetic and other medical supplies)
- Orthotics and prosthetics
- Home infusion therapy
- Diabetic and other medical supplies
You may also call CareCentrix at 1-855-243-3321 to find a Horizon Care@Home participating ancillary services provider.
For home health services (including in-home nursing services, physical therapy, occupational therapy and speech therapy), you must obtain prior authorization using Horizon BCBSNJ's online utilization management request tool via NaviNet.
As part of the review of a request for home care services to be provided, Horizon BCBSNJ or CareCentrix may contact your office for information required to conduct/complete their review.
Members with BlueCard® Coverage
As a reminder, you have the ability through NaviNet to access the online prior authorization tools of other Blue Plans to review/initiate prior authorizations online for BlueCard® members.
Members with BlueCard® coverage who are enrolled through another Blue Cross and/or Blue Shield Plan and are receiving care in New Jersey would access in-network home care services through a participating Horizon Care@Home provider; however, prior authorization requirements may vary based on the member's benefits.
Simply log in to NaviNet.net and:
- Mouse over Referrals and Authorization.
- Select Pre-Service Review for Out-of-Area Members.
After entering the member's alpha prefix, you'll be routed to the member's Home Plan. You can then follow the prompts to review a member's pre-service authorization requirements as well as submit a prior authorization request, if necessary.