Horizon PPO Network
We value our relationships with our participating physicians and health care professionals. They are key to Making Healthcare Work for our customers and the communities we serve.
Physicians and health care professionals in our Horizon PPO Network primarily treat Horizon Blue Cross Blue Shield of New Jersey members who are enrolled in Horizon PPO or Indemnity plans. Participating physicians and health care professionals are required to meet our credentialing standards. Participating physicians and other health care professionals have agreements with us to participate in the Horizon PPO Network.
We encourage members 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 health care professional 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 in New Jersey or one of the above-noted counties in New York, Pennsylvania or Delaware and you meet our credentialing criteria, you are eligible to participate in our Horizon PPO Network.
Joining the Horizon PPO Network
To consider you for participation in the Horizon PPO 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 additional required information.
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, pathologists, 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 PPO 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.
Physicians or other health care professionals who have opted out of, or are excluded from, Medicare are eligible to participate in the Horizon PPO Network. However, these practitioners are not eligible to receive reimbursement for services rendered to a patient enrolled in any Medicare Advantage plan.
CAQH ProView™ is a trademark of the Council for Affordable Quality Healthcare.