Horizon Managed Care Network
We value our relationships with our participating physicians and health care professionals.
Physicians and health care professionals who participate in our Horizon Managed Care Network treat members who are enrolled in one of our managed care products, which include:
- OMNIA Health Plans
- Horizon Direct Access
- Horizon EPO
- Horizon HMO
- Horizon POS
- NJ DIRECT
- Horizon Medicare Advantage plans
Many of these plans require members to select a Primary Care Physician (PCP) and to use participating physicians, other health care professionals and facilities. We encourage those members enrolled in managed care plans that include out-of-network benefits to use participating physicians, other health care professionals and facilities to help them maximize their benefits and ensure they are incurring the lowest possible out-of-pocket expenses.
Network area and current needs
We continually evaluate our networks to ensure we’re meeting the needs of our members throughout New Jersey and certain counties in New York (Bronx, Kings, New York, Orange, Richmond, Rockland and Westchester counties), Pennsylvania (Bucks, Delaware, Lehigh, Monroe, Northampton, Philadelphia and Pike counties) and Delaware (Kent, New Castle and Sussex counties).
If your primary practice address is within New Jersey or the above-noted counties in New York, Pennsylvania or Delaware listed above and you meet our credentialing criteria, you are eligible to participate in our Horizon Managed Care Network.
We are not currently accepting applications from pathologists, unless you are a hospital-based pathologist.
Joining the Horizon Managed Care Network
To consider you for participation in the Horizon Managed Care Network, you must provide us with information so that we may assess your credentials and ensure that you meet all criteria for participation.
Click the appropriate selection below for detailed instructions on submitting the additional information we require.
We strongly encourage the use of CAQH’s easy and efficient online provider data-collection service, CAQH ProView™, to make the majority of required information available to us. If you don’t already have a CAQH ProView Profile, please visit https://proview.caqh.org/pr to self-register to obtain your unique CAQH Provider ID number.
Anesthesiologists, radiologists and emergency medicine physicians affiliated ONLY with a hospital-based practice should complete and submit our Hospital-Based Physician form to be considered for participation in the Horizon Managed Care Network.
Horizon Behavioral Health
Behavioral health practitioners interested in joining our networks as part of the Horizon Behavioral Health program (administered by ValueOptions of New Jersey, Inc.) should call 1-800-397-1630 between 8 a.m. and 8 p.m., ET.
Medicare participation requirement
In addition to meeting our credentialing standards, physicians and other health care professionals who wish to join the Horizon Managed Care Network must also participate with Medicare. Physicians and other health care professionals who have opted out of Medicare may not participate in the Horizon Managed Care Network.
CAQH ProView™ is a trademark of the Council for Affordable Quality Healthcare.