Eligibility and Benefits Cost Share Estimator
Services requiring authorizations now included! Cost share results will let you know if the services require authorizations and where to submit the requests. |
Our Eligibility and Benefits Cost Share Estimator on NaviNet® is the fastest and easiest way to check medical and behavioral health claim-level member:
- Eligibility
- Benefit coverage
- Estimated out-of-pocket costs
- Services that require authorizations and where to submit requests
In addition, the results will provide you with a reference number confirming the date of your inquiry and the response.
Save Time
You no longer need to call Provider Services or rely on the printed member's ID card for this information. With just a single sign in to NaviNet, You can use this tool to check information for your patients enrolled in our Commercial and Medicare Advantage (including Braven℠ Health) plans with a member ID number that includes “3HZN”.
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.
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.
Eligibility and Benefits Cost Share Estimator
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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. The estimate will be based on information available on the date you submit an inquiry.
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).
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- 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.
- Revenue Codes: Use a four-digit revenue code. For example, enter 0110 for revenue code 110.
- Type of Service: Be sure to select “Psychiatric” from the drop down list for outpatient behavioral health services.
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- 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.
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