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Vendor Relationships

We collaborate with vendors and other business partners who share our commitment to quality and getting our members the care they need in a timely and convenient manner.

Advize Health™ and Cotiviti Healthcare
We have engaged the professional coders of Advize Health™ and Cotiviti Healthcare to conduct pre- and post-payment chart and claim audits of selected practices to help us ensure that high-level Evaluation and Management (E&M) codes and/or modifiers 25 and 59 are being submitted appropriately in relation to the services provided to our members.

AIM Specialty Health
We work with AIM Specialty Health to help manage certain advanced imaging and sleep study related services for our members enrolled in certain National Account self-insured groups.

CareCentrix credentials, manages and maintains the Horizon Care@Home network of ancillary services providers, arranges for delivery and conducts the utilization management for durable medical equipment, home infusion therapy, orthotics and prosthetics and diabetic and other medical supplies provided through the Horizon Care@Home program.

Davis Vision
Many Horizon Vision plans are administered through Davis Vision, with independent vision professionals and retailers in New Jersey and nationwide, including Visionworks retail locations.

eviCore healthcare
We partner with eviCore healthcare in the management of the following specialty programs: Radiology/Imaging Program, Cardiology Program, Radiation Therapy Program, Molecular and Genomic Testing Program, and our Musculoskeletal Program for Pain Management and Spine Surgery services.

Horizon BCBSNJ works with HearUSA and their HEARx Centers to provide audiology services, hearing aids and discounts on certain services to our eligible members enrolled in certain plans.

Magellan Rx Management
Magellan Rx Management, a specialty pharmaceutical management company, administers our Medical Injectables Program (MIP).

We work with McKesson to help ensure that our code and claim editing rules are accurate and consistent with standard business practice to enable us to process claims efficiently and provide accurate reimbursement.

naviHealth, LLC assists in the management of the post-acute Skilled Nursing Facility (SNF) and Inpatient Acute Rehab Facility (IRF) benefits for our Medicare Advantage and Horizon Medicare Advantage NJ DIRECT (PPO) members.

NaviNet, a multi-payer web portal, provides access to the important Horizon BCBSNJ information (eligibility, benefits, claims status, online explanations of payments, etc.) needed to conduct business with us on a day-to-day basis. Participating physicians and other health care professionals are required to register for and use NaviNet.

Prime Therapeutics
Horizon BCBSNJ’s contracted pharmacy benefit manager is Prime Therapeutics LLC.