Prior Authorization You can look up CPT or HCPCS codes to determine if a medical, surgical, or diagnostic service requires prior authorization for a Horizon member.
This application only applies to Commercial Fully Insured, New Jersey State Health Benefits Program (SHBP) or School Employees' Health Benefits Programs (SEHBP), Braven Health, Medicaid and DSNP plans. ADMINISTRATIVE SERVICES ONLY (ASO) accounts, with the exception of SHBP/SEHBP plans, are excluded.
The information provided by this tool is not intended to replace or modify the terms, conditions limitations and exclusions contained within health benefit plans issued or administered by Horizon. In the event a conflict between the information contained on the tool and member plan documents, member plan documents shall prevail.
It is intended for informational purposes only. The results provided by this tool are not a guarantee of payment. Claim processing is subject to member eligibility and all member and group benefit limitations, conditions and exclusions.