Referral Process Using the Interactive Voice Response System

Access the Interactive Voice Response (IVR) system 24/7 at 1-800-624-1110.

The following health care professionals can submit referrals through Horizon Blue Cross Blue Shield of New Jersey’s IVR:

• Primary Care Physicians (PCPs) and Ob/Gyns in the Horizon Managed Care Network may submit initial referrals to specialists in the network. These are called primary referrals. Ob/Gyns may issue primary referrals for Ob/Gyn-related services only.
• Specialists in the Horizon Managed Care Network may submit secondary referrals to network radiologists, same-day surgery centers and hospitals. These are called refer-on referrals.

General tips

• Listen carefully to the prompts and speak your response in a clear voice.
• If you think you made a mistake in entering information, simply wait.
• To return to the main menu at any time, say main menu.

To submit a referral, you will need:

• Either your provider ID number, tax identification number (TIN) or National Provider Identifier (NPI).
• The ID number or Social Security Number of the patient being referred.
• The birth date (month, date and year) of the patient being referred.
• The electronic tax identification number (ETIN), TIN, NPI or Medicare ID of the specialist or facility the patient is being referred to.
• Your fax number to receive a fax copy of the referral (optional).

Submitting a primary referral

1. From the IVR main menu, say referrals or press 4.
2. From the Referrals menu, say submit or press 1.
3. Say primary or press 1.
4. Say or enter the patient’s ID number or Social Security Number.
5. Say or enter the patient’s eight-digit date of birth (mm/dd/yyyy).
6. Say or enter the ETIN, TIN, NPI or Medicare ID of the specialist who you are referring the patient to.
7. Say or enter the number of visits. The maximum number of visits per referral is 12. The maximum number of dialysis visits per referral is 160.
8. Confirm the information you have entered, when prompted.
9. Say or enter your fax number, when prompted.
10. Listen for and make note of the referral number.

Submitting a secondary (or refer-on) referral

1. From the IVR main menu, say referrals or press 4.
2. From the Referrals menu, say submit or press 1.
3. Say secondary or press 2.
4. Say or enter the referral number for the applicable primary referral. You may enter it on the key pad if it is all numeric digits.
5. Say or enter the ETIN of the radiologist, same-day surgery center or hospital that you are referring to.
6. Follow steps 7 through 10 under the Submitting a primary referral section above.

Checking referral status on the IVR

1. From the IVR main menu, say referrals or press 4.
2. From the Referrals menu, say status or press 2.
3. Say or enter the patient’s ID number or Social Security Number.
4. Say or enter the patient’s eight-digit date of birth (mm/dd/yyyy).
5. Listen for a list of referral status records.
6. Listen for your opportunity to provide your fax number to request a fax copy of the referral.

Viewing referral confirmations online

1. A few minutes after submitting a referral through the IVR, log in to NaviNet.net and access the Horizon BCBSNJ Plan Central page.
2. Mouse over Referrals and Authorization and click Referral/Authorization Inquiry.
3. Complete the required fields and click Search to locate your referral.
4. Click the appropriate Referral Confirmation Number to see the referral details.

Prior authorization is a component of Horizon BCBSNJ’s managed care products. The IVR referral system does not replace Horizon BCBSNJ’s prior authorization programs including, but not limited to, elective hospital admissions, eviCore healthcare’s Advanced Imaging Services’ prior authorization and physical therapy requirements. Please refer to your Horizon BCBSNJManaged Care Office Manual for a list of services requiring prior authorization.