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NaviNet

All participating physicians and health care professionals are required to register for NaviNet within 30 days of their effective date of participation.

Through NaviNet, your office has access to the important Horizon information and self-service tools needed to conduct business with us on a day-to-day basis. From the Horizon BCBSNJ plan page, you can access:

  • Claim Management – View the status of a claim or payment, review claim editing rules through Clear Claim Connection or access to enroll or make changes to Electronic Funds Transfer (EFT) to enroll or make changes.
  • Eligibility and Benefits – Use our Eligibility and Benefits Cost Share Estimator to access medical and behavioral health claim-level member eligibility, benefits and out-of-pocket costs. You can also access a patient’s member ID card.
  • Frequently Asked Questions (FAQs) – View FAQs on various topics including claims, eligibility, benefits, referrals and authorizations. You can also learn how to access reports including capitation and panel reports.
  • Provider Data Maintenance Tool – Your NaviNet Security Officer can access the Provider Data Maintenance Tool to quickly and conveniently make changes to your provider information which we display to your Horizon BCBSNJ and Horizon NJ Health patients.
  • Referrals & Authorizations – Access our Medical Policies or prior authorization process and have access to our Prior Authorization Procedure Search Tool and Utilization Management Request Tool.
  • Provider Reference Materials - Find a wealth of important reference materials under References and Resources, including:
    • Current and past issues of Blue Review, our network newsletter
    • Claims, reimbursement and billing, and utilization management guidelines
    • Educational classes and webinars, including NaviNet training.
    • Updates on medical policies at least 30 days in advance of their effective dates
    • Network Office Manuals
    • News and legal notices
    • Our prescription drug formularies
    • And much more

Some content may be reserved for participating physicians, health care professionals and facilities. To view this reserved content, you must access our information through NaviNet.