The Ancillary Provider Office Manual

Updated On: January 2, 2023

Horizon Blue Cross Blue Shield of New Jersey's Ancillary Provider Office Manual is designed to make it as easy as possible for you to answer day-to-day questions and provide services to patients enrolled in our products.

This manual includes information about the plans we offer as well as information about our administrative procedures, policies and guidelines. If you are unable to find what you need in this manual, service numbers and directions to help you access content online are provided.

Failure to comply with the policies and procedures addressed in this manual may constitute a breach of your:

• Ancillary Services Provider Agreement – an agreement established between you and Horizon Healthcare of New Jersey, Inc. for participation in the Horizon Managed Care Network.
• Ancillary Services Provider Agreement – an agreement established between you and Horizon Healthcare Services, Inc. dba Horizon Blue Cross Blue Shield of New Jersey for participation in the non-managed care network (also referred to as the Horizon PPO Network).
• Ancillary Services Provider Agreement – an agreement established between you and Horizon Healthcare Services, Inc. dba Horizon Blue Cross Blue Shield of New Jersey for participation in both the managed and non-managed care networks. Note: the non-managed care network is also referred to as the Horizon PPO Network.

All participating ancillary providers are required to register for:

• NaviNet®, a multi-payer web portal that provides online access to important plan information you will need to conduct your day-to-day business with us, within 30 days of your effective date of participation.
• Electronic Funds Transfer (EFT) – Horizon BCBSNJ requires all ancillary providers to register for EFT upon joining our networks.

Horizon BCBSNJ will primarily communicate with you electronically.

Log in to NaviNet.net, access Horizon BCBSNJ within the My Health Plans menu, mouse over References and Resources and click Provider Reference Materials to access and review all posted news and legal notices, office manuals, newsletters, policies, rules, procedures, credentialing/recredentialing guidelines, etc.

Updates to the information in this manual will be posted online and/or included in Blue Review, our network newsletter for participating physicians, ancillary providers and staff of ancillary and acute care facilities.

To access current and past issues of Blue Review, registered NaviNet users may log on to NaviNet.net, access Horizon BCBSNJ within the My Health Plans menu and:

• Mouse over References and Resources.
• Select Provider Reference Materials.
• Mouse over Resources and select Newsletters, then Blue Review.

We hope you find this manual helpful. We value our relationship with your office or facility and look forward to building and maintaining our relationship with you.

Use the links below to access information you are looking for.

ALL RIGHTS RESERVED. No part of this manual may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storing and retrieval system, without the prior written permission of Horizon BCBSNJ.

All trademarks are the properties of their respective owners.

This manual contains prescription brand name medications that are registered marks or trademarks of pharmaceutical manufacturers that are not affiliated with either Horizon Blue Cross Blue Shield of

New Jersey or the Blue Cross Blue Shield Association.

Prefix information included in this manual is confidential. Participating Horizon BCBSNJ physicians and other health care professionals and their office staff agree to use this information only to identify health insurance claims/service contact information for Horizon BCBSNJ and/or other Blue Cross and/or Blue Shield Plan patients and not for other purposes and will not divulge any such information to any other party. Reproduction of this information, in whole or in part, is prohibited without the permission of Horizon BCBSNJ.