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Eligibility and Benefits Cost Share Estimator

Our Eligibility and Benefits Cost Share Estimator on NaviNet® gives you access to medical and behavioral health claim-level member eligibility, benefits and out-of-pocket costs. This tool, available to all providers who are registered with NaviNet, provides you with information for your patients enrolled in our Commercial and Medicare Advantage (including Braven℠ Health) plans with a member ID number that includes “3HZN”.

With this tool and our other online resources, you no longer need to contact Provider Services or rely on printed member ID cards to confirm your patient’s eligibility and benefit information. If the member ID number does not include “3HZN”, please continue to call the Provider Services number on the member’s ID card for information.

Reference number provided
After you complete an inquiry, the Eligibility and Benefits Cost Share Estimator will provide you with a reference number for your records. If necessary at a future date, this reference number can be provided to our Service teams so they can quickly access the information you were provided as part of your interaction.

How to access the new tool
Access the Horizon BCBSNJ plan central page on NaviNet, then:

  • - Select Eligibility and Benefits from the Workflows for this Plan menu
  • - Click on Cost Share Estimator

You will need to enter your provider Tax ID number and other required information to view the member’s coverage eligibility, estimated deductible, copay, coinsurance and visit limits. The estimate will be based on information available on the date you submit an inquiry. The tool will give you:

  • - Estimated benefit and cost share information for up to a total of 15 procedure/HCPCS/revenue codes and up to five diagnosis codes.
  • - A reference number confirming the date of your inquiry and the response.

The information provided is not a guarantee of payment. Any payment is subject to the member’s health plan, eligibility, benefits, medical policy and medical necessity/appropriateness at the time of service. Member cost-sharing amounts may vary based on claims processed following your estimate.

The benefits and services shown in the estimate are based on the information available at the time of the inquiry and do not represent a complete listing of the member’s benefits, eligibility or out-of-pocket costs and may not reflect recent changes related to federal and/or state mandate(s).

Helpful Hints

  • You must continue to contact us for eligibility and cost information for services requiring authorizations or medical necessity reviews and services requiring combined revenue and HCPCS codes.
  • Provider ID:
    • Professional Providers: Select the TIN/suffix combination for the rendering provider’s specialty.
    • Ancillary Facilities: After selecting your TIN, then select your six-digit Provider ID.
    • If you need assistance, call Provider Services at 1-800-624-1110.
  • Diagnosis Codes: Use ICD-10 codes to the highest level of specificity.
  • Type of Service: Be sure to select “Psychiatric” from the drop down list for outpatient behavioral health services.

Questions

  • Provider Services: 1-800-624-1110, weekdays, 8 a.m. to 5 p.m., Eastern Time (ET).
  • Institutional Services: 1-888-666-2535, weekdays, 8 a.m. to 5 p.m., ET.
  • Behavioral health providers can also email: BHNetworkRelations@HorizonBlue.com. Please include your name, NPI and county.
  • Technical support: eService Desk at 1-888-777-5075, weekdays, 7 a.m. to 6 p.m., ET.