Identification

The member’s ID card is an important tool in determining the product in which your patient is enrolled. Most cards include general coverage and copayment information, as well as important phone numbers. Both the front and back of the ID card contain important information.

The member’s identification (ID) number is the most important link between you, your patient and  Horizon BCBSNJ. It is critical that you include all numeric characters when submitting claims to us.

As an ancillary provider who participates in our Horizon Managed Care Network and/or our Horizon PPO Network, you must, according to the terms of your Agreement, accept our allowance for  eligible services provided to Horizon BCBSNJ members (less any applicable copayment, coinsurance or deductible amounts) as payment in full.

For more information about allowances for services provided to members in various Horizon BCBSNJ plans, please see the Claims Submissions and Reimbursement section beginning on page 16.

SAMPLE ID CARDS

Horizon BCBSNJ’s ID cards comply with Blue Cross and Blue Shield Association (BCBSA) branding regulations and New Jersey Department of Banking and Insurance (DOBI) regulations.

Our ID cards contain the important information you need in a uniform and consistent layout so that Horizon BCBSNJ ID cards – and all other Blue Plan ID cards – are easy to read and use.

The images that follow are not actual ID cards. They are for educational purposes only.

1. Member name.
2. Member ID number.
3. Coverage verification data.
4. The name of the product.
5. Copayment information, including inpatient hospital copayment. This information will vary based on the plan.
6. PPO-in-a-suitcase logo indicates BlueCard PPO coverage, if applicable.
7. The Primary Care Physician’s (PCP) name (if a PCP is required under the plan).
8. Claim filing information. This information will vary based on the plan.
9. Logo indicating prescription drug coverage, if the member has Prime Therapeutics LLC prescription drug coverage through Horizon BCBSNJ.
10. Website address.
11. Service phone numbers. This information may vary based on the plan.
12. Indication of whether the plan is insured or self-funded. A self-funded ID card will state, Horizon BCBSNJ provides administrative services only and does not assume any financial risk for claims.

Sample National ID Card

1. Member name.
2. Member ID number.
3. Coverage verification data.
4. The name of the plan.
5. Copayment information, including inpatient hospital copayment. This information will vary based on the plan.
6. PPO-in-a-suitcase logo indicates BlueCard PPO coverage, if applicable.
7. Claim filing information. This information will vary based on the plan.
8. Logo indicating prescription drug coverage, if the member has Prime Therapeutics LLC prescription drug coverage through Horizon BCBSNJ.
9. Website address.
10. Service phone numbers.
    This information may vary based on the plan.
11. Indication of whether the plan is insured or self-funded. A self-funded ID card will state, Horizon BCBSNJ provides administrative services only and does not assume any financial risk for claims.

FEDERAL EMPLOYEE PROGRAM® (FEP®): ID CARDS

1. Member name.
2. Member ID number.
   All characters in this field are important and must be included in all transactions.
   For FEP plans, the ID number always begins with the R prefix and is followed by eight digits.
3. Enrollment Code.
   • 104 identifies Standard Option self coverage.
   • 105 identifies Standard Option self and family coverage.
   • 106 identifies Standard Option self plus one coverage.
   • 111 identifies Basic Option self coverage.
   • 112 identifies Basic Option self and family coverage.
   • 113 identifies Basic Option self plus one coverage.
   • 131 identifies self coverage.
   • 132 identifies self plus one coverage.
   • 133 identifies self and family coverage.
4. Effective date of the subscriber’s contract.
5. The ID card will also have either PPO or Basic in the upper right corner of the ID card, inside the outline of the U.S. map.

   

Braven Health ID CARDS

1. Member ID name.
2. Member ID number.
3. Coverage verification data.
4. The name of the product.
5. Copayment information, including inpatient hospital copayment. This information will vary based on the plan.
6. Icon in corner indicates plan type.