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COVID-19 InformationCOVID-19 Information
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- Behavioral Health Continuity During the COVID-19 Public Health EmergencyBehavioral Health Continuity During the COVID-19 Public Health Emergency
- COVID-19 Frequently Asked QuestionsCOVID-19 Frequently Asked Questions
- Members Will Incur No Costs for Treatment of COVID-19Members Will Incur No Costs for Treatment of COVID-19
- Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility AdmissionsWaiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility Admissions
- Horizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health ProfessionalsHorizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health Professionals
- Reminder to use specific codes when evaluating for COVID-19Reminder to use specific codes when evaluating for COVID-19
- COVID-19 Update: Authorizations Waived for Oxygen Following ER DischargeCOVID-19 Update: Authorizations Waived for Oxygen Following ER Discharge
- COVID-19 Update: Telemedicine Reimbursement Policy AddendaCOVID-19 Update: Telemedicine Reimbursement Policy Addenda
- Provisionally Join Horizon BCBSNJ Network(s) to Assist with the COVID-19 PandemicProvisionally Join Horizon BCBSNJ Network(s) to Assist with the COVID-19 Pandemic
- Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissionsWaiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions
- Providing Telephonic care with no costs to membersProviding Telephonic care with no costs to members
- COVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine ServicesCOVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine Services
- COVID-19 CPT testing codesCOVID-19 CPT testing codes
- Eliminating Cost Sharing Related to COVID-19 Testing and EvaluationEliminating Cost Sharing Related to COVID-19 Testing and Evaluation
- Staying Informed: COVID-19 CoronavirusStaying Informed: COVID-19 Coronavirus
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Interactive Voice Response System (IVR)Interactive Voice Response System (IVR)
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Surgical and Implantable Device Management ProgramSurgical and Implantable Device Management Program
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Demographic UpdatesDemographic Updates
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Inquiries, Complaints & AppealsInquiries, Complaints & Appeals
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PoliciesPolicies
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Administrative PoliciesAdministrative Policies
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- Allowable Practice Locations for PathologistsAllowable Practice Locations for Pathologists
- Appointment Availability Access Standards for Primary Care-Type Providers, ObGyns and SpecialistsAppointment Availability Access Standards for Primary Care-Type Providers, ObGyns and Specialists
- Behavioral Health Providers Access StandardsBehavioral Health Providers Access Standards
- Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) ProvidersCredentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers
- Credentialing and Recredentialing Policy for Participating Physicians and Healthcare ProfessionalsCredentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals
- EDI and NaviNet Claims Submission RequirementEDI and NaviNet Claims Submission Requirement
- Electronic Funds Transfer (EFT)Electronic Funds Transfer (EFT)
- Material Adverse Change (MAC) Notification PolicyMaterial Adverse Change (MAC) Notification Policy
- Medical Records Documentation StandardsMedical Records Documentation Standards
- Medicare Advantage ReadmissionMedicare Advantage Readmission
- Never EventsNever Events
- Out-of-Network Referral PolicyOut-of-Network Referral Policy
- Physician and Healthcare Professional Counseling and Termination Policy - Professional CompetencyPhysician and Healthcare Professional Counseling and Termination Policy - Professional Competency
- Participation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon NetworkParticipation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon Network
- Practitioner Office Site Quality and Medical Record Keeping StandardsPractitioner Office Site Quality and Medical Record Keeping Standards
- Provider Directory ManagementProvider Directory Management
- Retainer Based MedicineRetainer Based Medicine
- Tier Awareness PolicyTier Awareness Policy
- Use of Horizon Hospital Network Performance DataUse of Horizon Hospital Network Performance Data
- Use of Practitioner Performance DataUse of Practitioner Performance Data
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- BlueCard Medical PoliciesBlueCard Medical Policies
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Reimbursement Policies & GuidelinesReimbursement Policies & Guidelines
- Reimbursement Policies & Guidelines
- After-hours and Weekend CareAfter-hours and Weekend Care
- Ambulance ServicesAmbulance Services
- Ambulatory Electrocardiographic MonitoringAmbulatory Electrocardiographic Monitoring
- Anesthesia Reimbursement GuidelinesAnesthesia Reimbursement Guidelines
- ASC Multiple Procedure MethodologyASC Multiple Procedure Methodology
- Assistant at SurgeryAssistant at Surgery
- Balloon SinuplastyBalloon Sinuplasty
- Bariatric Surgery Billed With Hiatal Hernia RepairBariatric Surgery Billed With Hiatal Hernia Repair
- Bilateral ProceduresBilateral Procedures
- Billing Guidelines for Maternity ServicesBilling Guidelines for Maternity Services
- Cardiac Event DetectionCardiac Event Detection
- Cardiovascular Implant Device Monitoring ServicesCardiovascular Implant Device Monitoring Services
- Chemotherapy AdministrationChemotherapy Administration
- Chronic Care Management ServicesChronic Care Management Services
- Claim Editing PoliciesClaim Editing Policies
- Claims Requiring Additional DocumentationClaims Requiring Additional Documentation
- ClaimsXten Editing RulesClaimsXten Editing Rules
- Clinical Trials Support ProgramClinical Trials Support Program
- Co-Surgeon ReimbursementCo-Surgeon Reimbursement
- Colonoscopy with Modifier 59Colonoscopy with Modifier 59
- Conscious SedationConscious Sedation
- Consultation Services PaymentConsultation Services Payment
- Consumable Medical SuppliesConsumable Medical Supplies
- Continuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) SuppliesContinuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) Supplies
- Daily Management of Epidural or Subarachnoid Continuous Drug AdministrationDaily Management of Epidural or Subarachnoid Continuous Drug Administration
- Daily Maximum Units for Surgical Pathology and Microscopic ExaminationDaily Maximum Units for Surgical Pathology and Microscopic Examination
- Determination of Refractive StateDetermination of Refractive State
- Diabetic Screening ServicesDiabetic Screening Services
- Diabetic SuppliesDiabetic Supplies
- Distinct Procedural Service ModifiersDistinct Procedural Service Modifiers
- DME Rent to PurchaseDME Rent to Purchase
- Drug and Immunization PricingDrug and Immunization Pricing
- Duplex ScanningDuplex Scanning
- Drug Wastage – Modifier JWDrug Wastage – Modifier JW
- Duplicate Claim Logic for Independent Laboratory ServicesDuplicate Claim Logic for Independent Laboratory Services
- Enhancement to CMS Always Bundled EditEnhancement to CMS Always Bundled Edit
- Evaluation and Management Services with Chiropractic Manipulative TreatmentEvaluation and Management Services with Chiropractic Manipulative Treatment
- Evaluation and Management Services with Osteopathic Manipulative TreatmentEvaluation and Management Services with Osteopathic Manipulative Treatment
- Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion ImagingEvaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion Imaging
- Frequency of Care Coordination Services and ESRD ProceduresFrequency of Care Coordination Services and ESRD Procedures
- Frequency of G0179Frequency of G0179
- Hip ArthroscopyHip Arthroscopy
- Hot or Cold Pack TherapyHot or Cold Pack Therapy
- Inpatient ConsultationsInpatient Consultations
- Knee ArthroscopyKnee Arthroscopy
- Lab Panel RebundlingLab Panel Rebundling
- Laboratory Services Billed by PhysiciansLaboratory Services Billed by Physicians
- Maternity ReimbursementMaternity Reimbursement
- Microsurgery and Robotic SurgeryMicrosurgery and Robotic Surgery
- Modifier 25Modifier 25
- Modifier 50 Bilateral GuidelinesModifier 50 Bilateral Guidelines
- Modifier 52Modifier 52
- Modifier 53Modifier 53
- Modifier 54Modifier 54
- Modifier 55Modifier 55
- Modifier 56Modifier 56
- Modifier 57Modifier 57
- Modifier 76Modifier 76
- Modifier 77Modifier 77
- Modifier 78Modifier 78
- Modifier SUModifier SU
- Multiple Procedure ReductionsMultiple Procedure Reductions
- Mutually and Non-Mutually Exclusive NCCI Supplemental EditsMutually and Non-Mutually Exclusive NCCI Supplemental Edits
- Non-ESRD ESA Level ReportingNon-ESRD ESA Level Reporting
- Noncovered Related ServicesNoncovered Related Services
- Outpatient ConsultationsOutpatient Consultations
- Outpatient Laboratory Claims: Referring Practitioner RequiredOutpatient Laboratory Claims: Referring Practitioner Required
- Outpatient Therapy Daily MaximumOutpatient Therapy Daily Maximum
- Physician Extenders Non-Surgical ServicesPhysician Extenders Non-Surgical Services
- Pre-Admission TestingPre-Admission Testing
- Pulmonary Diagnostic Procedures when billed with E&M CodesPulmonary Diagnostic Procedures when billed with E&M Codes
- Radiology, Preliminary and Double ReadsRadiology, Preliminary and Double Reads
- RadiopharmaceuticalsRadiopharmaceuticals
- Reimbursement and Billing Guidelines for Anesthesia ClaimsReimbursement and Billing Guidelines for Anesthesia Claims
- Removal of Impacted Cerumen Requiring InstrumentationRemoval of Impacted Cerumen Requiring Instrumentation
- Screening and Diagnostic Mammography & 3D TomosynthesisScreening and Diagnostic Mammography & 3D Tomosynthesis
- Site of Service DifferentialSite of Service Differential
- Smoking CessationSmoking Cessation
- Status N CodesStatus N Codes
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Telemedicine ServicesTelemedicine Services
- Telemedicine Services
- Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and productsTelemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and products
- Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare AdvantageTelemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare Advantage
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- Ulcer Debridement and Ulcer StagesUlcer Debridement and Ulcer Stages
- Urinalysis with Evaluation and Management (E&M) ServicesUrinalysis with Evaluation and Management (E&M) Services
- Urine Drug Screening/TestingUrine Drug Screening/Testing
- Vitamin D TestingVitamin D Testing
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Utilization ManagementUtilization Management
- Utilization Management
- Clinical Practice GuidelinesClinical Practice Guidelines
- PT/OT Outpatient Prior Authorization for Horizon Medicare Advantage PlansPT/OT Outpatient Prior Authorization for Horizon Medicare Advantage Plans
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Services Requiring Prior AuthorizationServices Requiring Prior Authorization
- Services Requiring Prior Authorization
- Prior Authorization Procedure Search ToolPrior Authorization Procedure Search Tool
- BlueCard MembersBlueCard Members
- Medicare AdvantageMedicare Advantage
- OMNIA Health PlansOMNIA Health Plans
- SHBP/SEHBPSHBP/SEHBP
- Unite Here HealthUnite Here Health
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- Utilization Management Request ToolUtilization Management Request Tool
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ResourcesResources
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Manuals & User GuidesManuals & User Guides
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- AgreementsAgreements
- Ancillary ManualAncillary Manual
- Benefits-at-a-GlanceBenefits-at-a-Glance
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Participating Physician and Other Health Care Professional Office ManualParticipating Physician and Other Health Care Professional Office Manual
- Participating Physician and Other Health Care Professional Office Manual
- At Your ServiceAt Your Service
- The BlueCard ProgramThe BlueCard Program
- Claims Submissions and ReimbursementClaims Submissions and Reimbursement
- Coordination of BenefitsCoordination of Benefits
- HIPAAHIPAA
- Horizon Behavioral HealthHorizon Behavioral Health
- Horizon Hospital NetworkHorizon Hospital Network
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- Member Rights and ResponsibilitiesMember Rights and Responsibilities
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- Payment Summaries and VouchersPayment Summaries and Vouchers
- Policies, Procedures and General GuidelinesPolicies, Procedures and General Guidelines
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- Welcome Kit HandbookWelcome Kit Handbook
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TrainingTraining
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EducationEducation
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Online ToolsOnline Tools
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- Electronic Funds TransferElectronic Funds Transfer
- Health Risk AssessmentHealth Risk Assessment
- Radiation Therapy Medical Necessity DeterminationRadiation Therapy Medical Necessity Determination
- Utilization Management Request ToolUtilization Management Request Tool
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- Horizon NJ TotalCare (HMO D-SNP) FormsHorizon NJ TotalCare (HMO D-SNP) Forms
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- Frequently Used FormsFrequently Used Forms
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- W9 Form-DentalW9 Form-Dental
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