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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 select 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.

Register Today for One of Our Upcoming Training Sessions

Our new training session will provide an overview of our Eligibility and Benefits Cost Share Estimator and review tips and instructions to help you get the most out of this important new tool.

Questions

Eligibility and Benefits Cost Share Estimator

Transcript

We have an online tool to make your day-to-day interactions with us easier.

Introducing the Eligibility and Benefits Cost Share Estimator.

With this tool, your staff can save time and administrative costs by going online for the information you need.

Before providing care, you can easily find coverage eligibility and an estimate of your patient’s liability for the services requested.

The results will be based on the date you submit an inquiry.

With 24/7 online access to this accurate information, you don’t need to call Provider Services to check member eligibility and cost share or ask to see a printed member ID card during check in.

Let’s see how easy it is to access member medical and behavioral health eligibility, benefits and estimated out-of-pocket costs for your patients enrolled in Horizon Commercial, Horizon Medicare Advantage and Braven Health℠ plans.

These are our members with “3HZN” included in their member ID numbers.

Simply log in to NaviNet and access Horizon’s Plan Central page. Under Eligibility and Benefits, click on Cost Share Estimator.

Once you access the tool, just follow five easy steps.

Enter the required member information along with your information and details about the services, including:

  • place of service, or for facilities, type of bill
  • up to five diagnosis codes
  • up to fifteen CPT and/or Hick Picks (HCPCS) codes, and when necessary, use modifiers or for facilities up to fifteen revenue codes
  • the type of service and the billed amount

After you review your entries, you’ll receive the results within seconds, along with a reference number that you can use if you have questions after providing services.

And, you can easily check another Horizon patient by simply selecting New Inquiry.

Think of the time you will save using the Eligibility and Benefits Cost Share Estimator.

Please visit HorizonBlue.com/costtool for more information about this self-service tool and available training for you and your office staff.