Home Feed

Member Portal Scheduled Maintenance

horizonbcbsnj — Fri, 13 Dec 2019 17:41:24 +0000

Member Portal Scheduled Maintenance Fri, 12/13/2019 - 12:41

Horizon BCBSNJ's Member Portal will undergo scheduled maintenance beginning at 6 a.m. December 14, 2019 until 8 a.m. December 14, 2019. We apologize for the inconvenience and appreciate your patience.

Medical Policy Update: Biofeedback

horizonbcbsnj — Thu, 12 Dec 2019 21:25:42 +0000

Medical Policy Update: Biofeedback Thu, 12/12/2019 - 16:25

Effective January 14, 2020, Horizon BCBSNJ will change the way we consider certain professional claims based on an update to our medical policy, Biofeedback.

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided on and after January 14, 2020 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows.

Based on the submitted diagnosis code(s), the services represented by CPT® code 90901 may be denied as an experimental/investigational non-covered service.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will be applied to claims for dates of service on and after January 14, 2020.

CPT® is a registered mark of the American Medical Association.

¹The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.

Medical Policy Update: Temporomandibular Joint Dysfunction

horizonbcbsnj — Thu, 12 Dec 2019 21:17:42 +0000

Medical Policy Update: Temporomandibular Joint Dysfunction Thu, 12/12/2019 - 16:17

Effective January 14, 2020, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Temporomandibular Joint Dysfunction.

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided on and after January 14, 2020 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows.

Regardless of the submitted diagnosis, the services represented by CPT® codes 90875 and 90876 will be denied as not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, based on a national coverage determination or local coverage determination.
Based on the submitted diagnosis code(s), the services represented by CPT code 90901 may be denied as experimental/investigational non-covered services.
Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by CPT code 90901. Following our review of medical record information, these services may be denied as not medically necessary.
The services represented by CPT codes 95867, 95868 and 95927 will be excluded from the guidelines of this policy. These codes will be processed based solely on member benefits.
Regardless of the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by HCPCS codes J7323, J7324, J7325 or J7327. Following our review of medical record information, these services may be denied as not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, based on a national coverage determination or local coverage determination.

CPT® is a registered mark of the American Medical Association.

Claim Adjustments to be Performed: Clinical Laboratory Services

horizonbcbsnj — Fri, 06 Dec 2019 18:25:31 +0000

Claim Adjustments to be Performed: Clinical Laboratory Services Fri, 12/06/2019 - 13:25

Based on a recent review, Horizon BCBSNJ determined that certain claims for clinical laboratory services rendered between January 1, 2019 and September 19, 2019 to patients enrolled in plans that use the Horizon Managed Care Network were denied in error with the message below.

B685: This service is not paid. Laboratory services must be performed by a laboratory in the Preferred Network for Managed Care Products. There is no member liability for this service if performed by a participating provider.

On October 11, 2019, we corrected the issues causing these incorrect denials of clinical laboratory services included on certain claims submitted by participating and nonparticipating clinical labs as well as professional group practice locations with onsite laboratory capabilities.¹

On January 6, 2019, Horizon BCBSNJ will begin adjusting impacted claims for clinical laboratory services rendered between January 1, 2019 and October 10, 2019 to ensure that they are processed appropriately according to member benefits and eligibility.

Reimbursement details, including changes to member responsibility, will be included on Explanation of Payment statement(s) and member Explanation of Benefits (EOB) statements generated following each adjustment.

We thank you in advance for promptly reimbursing your patients for any amounts that you may have previously collected from them based upon the original adjudication of these impacted claims.

We apologize for any inconvenience.

If you have questions, please call Physician Services at 1-800-624-1110, Monday through Friday, between 8 a.m. and 5 p.m., Eastern Time.

¹Please note that the B685 message is appropriate for many clinical laboratory procedure codes and that not all claims denied with this message were denied in error.

Medical Policy Update: Aqueous Shunts and Stents for Glaucoma

horizonbcbsnj — Wed, 04 Dec 2019 15:35:20 +0000

Medical Policy Update: Aqueous Shunts and Stents for Glaucoma Wed, 12/04/2019 - 10:35

Effective January 4, 2020, we will change the way we consider certain services provided to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans based on an update to our medical policy, Aqueous Shunts and Stents for Glaucoma.

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided on and after January 4, 2020 to patients enrolled in Horizon BCBSNJ MA plans will be processed as follows.

Regardless of the submitted diagnosis codes, the services represented by CPT® codes 0253T, 0376T, 0450T, or E0474 will be denied as not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, based on a national coverage determination or local coverage determination.

Based on the submitted diagnosis code(s), the services represented by CPT codes 0191T or 0449T may be denied as not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, based on a national coverage determination or local coverage determination.

Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by CPT codes 0191T or 0449T. Following our review of medical record information, these services may be denied as not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, based on a national coverage determination or local coverage determination.

CPT® is a registered mark of the American Medical Association

Member Portal Scheduled Maintenance

horizonbcbsnj — Tue, 03 Dec 2019 21:04:01 +0000

Member Portal Scheduled Maintenance Tue, 12/03/2019 - 16:04

Horizon BCBSNJ's Member Portal will undergo scheduled maintenance beginning at 8 p.m. December 6, 2019 until 8 a.m. December 9, 2019. We apologize for the inconvenience and appreciate your patience.

2020 Quarterly Claim Editing Updates

horizonbcbsnj — Mon, 02 Dec 2019 05:15:27 +0000

2020 Quarterly Claim Editing Updates Mon, 12/02/2019 - 00:15

For 2020, Horizon BCBSNJ will continue our practice of implementing quarterly updates to our systems to help ensure that our code and claim editing rules are consistent with standard business practice and that reimbursements we make are accurate and appropriate.¹

We will continue to announce upcoming quarterly code and claim editing rules updates providing no less than 30 days’ notice. The effective dates of quarterly changes will reflect the first day of each respective quarter (i.e., January 1, April 1, July 1, October 1).²

On the first day of each quarter, we will implement claim editing updates related to rules/guidelines implemented by the Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) that will impact claims for services provided to patients enrolled in fully insured, Medicare Advantage, and State Health Benefits Program/School Employees’ Health Benefits Program (SHBP/SEHBP) plans.

Details of these updates may be accessed by visiting CMS web pages Quarterly PTP and MUE Version Update Changes and PTP Coding Edits.
Additional quarterly claim editing updates (including the NCCI edits noted above for all other members) will be implemented according to the schedule noted below (but may be subject to change):

Q1 edits will be implemented into our systems on or about February 1, 2020

Q2 edits will be implemented into our systems on or about May 1, 2020

Q3 edits will be implemented into our systems on or about August 1, 2020

Q4 edits will be implemented into our systems on or about November 1, 2020

Within our claim processing systems, the effective dates of these quarterly changes will reflect the first day of each respective quarter.²

Claims for services provided on and after the first day of a quarter that are processed prior to an announced implementation date will not reflect the quarterly changes announced. Horizon BCBSNJ will NOT seek to adjust claims for services provided on and after the first day of a quarter that are processed prior to an announced implementation date.

However, if a claim is adjusted following the implementation date of a quarterly update, and the claim is for a service provided on or after the first day of a quarter that was finalized prior to an announced implementation date, the claim will be processed based on the code and claim editing rules for that quarter.

MAC NOTIFICATION POLICY REMINDER
Horizon BCBSNJ will continue to provide 90 days’ advance notice for the implementation of new and/or revised Horizon BCBSNJ administrative, medical and/or reimbursement policies that result in a material adverse change as outlined in our Material Adverse Change (MAC) Notification Policy.

To access this administrative policy, log in to NaviNet.net, select Horizon BCBSNJ from the My Health Plans menu and:

Mouse over References and Resources and click Provider Reference Materials
Mouse over Policies & Procedures and click Policies
Click Administrative Policies

If you have questions, please call Physician Services at 1-800-624-1110 or Institutional Services at 1-888-666-2535, Monday through Friday, between 8 a.m. and 5 p.m., Eastern Time.

¹ We implement quarterly updates to help ensure that claims are processed using new and revised Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes, and that our claim editing rules and practices reflect the most current coding and code editing guidelines of nationally recognized sources including the Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI), Outpatient Code Editor (OCE), and International Classification of Diseases Clinical Modification (ICD-CM).

² Codes may periodically be added to or deleted from our code auditing software and are not considered changes to the software version. In some cases, CMS may implement changes with an effective date prior to the first day of the quarter. Horizon BCBSNJ will not change or revise those industry-standard dates

CLEAR CLAIM CONNECTION
You can review how updated claim editing rules impact reimbursement for certain code combinations by using Change Healthcare’s Clear Claim Connection tool available via NaviNet®.

To access Clear Claim Connection:

Log in to NaviNet.netand select Horizon BCBSNJ from the My Health Plans menu
Mouse over Claim Management and click Clear Claim Connection

Horizon BCBSNJ makes our Medical Policies, Administrative Policies, Reimbursement Policies and Guidelines and information about our Claim Editing Policies available on HorizonBlue.com/policies.

CPT® is a registered mark of the American Medical Association.
NaviNet® is a registered trademark of NaviNet, Inc.

January 2020 Update: Radiology/Imaging Services Program and Cardiology Imaging Program

horizonbcbsnj — Sat, 30 Nov 2019 04:33:07 +0000

January 2020 Update: Radiology/Imaging Services Program and Cardiology Imaging Program Fri, 11/29/2019 - 23:33

Horizon BCBSNJ will implement changes to the services included as part of our Radiology/Imaging Services Program and our Cardiology Imaging Program, both administered by eviCore healthcare (eviCore).

eviCore will conduct Prior Authorization/Medical Necessity Determination (PA/MND) reviews of the additional Nuclear Medicine, Nuclear Cardiac Imaging and Echocardiogram services represented by the recently approved procedure codes below when rendered on or after January 1, 2020.

78434
93356
78830
78831
78832

Effective for services to be provided January 1, 2020, and after, eviCore will no longer conduct PA/MND of the services represented by the following procedure codes as part of these programs.

0482T
78205
78320
78607
78647
78710
78805
78806
78807
78206

Review the complete list of services that require PA/MND review as part of these programs.

For more information about these and other eviCore programs, visit HorizonBlue.com/evicore. If you have questions, please contact your Network Specialist or Ancillary Contracting Specialist.

CPT® is a registered trademark of the American Medical Association.

PA/MND reviews
To submit a PA/MND request to eviCore (or to validate that a PA/MND was requested and/or approved) please:

Visit eviCore.com or
Call 1-866-496-6200, between 7 a.m. and 7 p.m., Eastern Time

Review the guidelines eviCore uses to conduct PA/MND reviews as part of this program.

Molecular and Genomic Testing Program Update: January 2020

horizonbcbsnj — Fri, 29 Nov 2019 06:23:33 +0000

Molecular and Genomic Testing Program Update: January 2020 Fri, 11/29/2019 - 01:23

Horizon Blue Cross Blue Shield of New Jersey will implement changes to the services included as part of our Molecular and Genomic Testing Program, administered by eviCore healthcare (eviCore) for members enrolled in Horizon BCBSNJ fully-insured products as well as administrative services only (ASO) accounts that participate in the Molecular and Genomic Testing Program.

eviCore will conduct pre-service Medical Necessity Determination (MND) reviews of the additional diagnostic testing services represented by the recently accepted codes noted below when rendered on and after January 1, 2020 in a physician’s office or clinical laboratory:¹
0153U
0156U
0157U
0158U
0159U
0160U
0161U
0162U
81277
81307
81308
81522
81542
81552
Effective January 1, 2020, services represented by CPT® code 0081U will no longer require pre-service MND review as part of the Molecular and Genomic Testing Program.

Review the complete list of molecular and genomic diagnostic testing services that require pre-service MND reviews.

More information about our Molecular and Genomic Testing Program is available. If you have questions, please contact your Network Specialist or Ancillary Contracting Specialist.

¹MND requirements will not apply to molecular and genomic diagnostic testing services rendered to patients in a hospital Emergency Room, hospital outpatient or inpatient setting or an Ambulatory Surgery Center (ASC).

CPT® is a registered trademark of the American Medical Association.

PRE-SERVICE MND REVIEWS
To obtain pre-service MND from eviCore (or to validate that a pre-service MND was requested and/or approved):

Visit.eviCore.com; or
Call 1-844-224-0493, between 7 a.m. and 7 p.m., Eastern Time.

Review the guidelines eviCore uses to conduct MND reviews as part of the Molecular and Genomic Testing Program.

Have a billing question?

horizonbcbsnj — Wed, 27 Nov 2019 15:57:40 +0000

Have a billing question? Wed, 11/27/2019 - 10:57

Have a billing question? We’re here for you. Click here for information on our extended hours.

Important Health Plan Announcement

horizonbcbsnj — Tue, 26 Nov 2019 20:56:52 +0000

Important Health Plan Announcement Tue, 11/26/2019 - 15:56

Magellan Health’s subsidiary, Magellan Rx Management, discovered a potential data breach related to protected health information. Learn more.

Medical Policy Update: Home Traction Devices for the Treatment of Spinal Disorders and Pain

horizonbcbsnj — Mon, 25 Nov 2019 21:20:42 +0000

Medical Policy Update: Home Traction Devices for the Treatment of Spinal Disorders and Pain Mon, 11/25/2019 - 16:20

Effective December 26, 2019, Horizon BCBSNJ will change the way we consider claims for certain home traction devices provided to Horizon BCBSNJ Medicare Advantage (MA) plan members.

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided on and after December 26, 2019 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows.

Regardless of the submitted diagnosis code(s), the services represented by HCPCS code E0856 will be denied as not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, based on a national coverage determination or local coverage determination.

¹ The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJMA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.

Medical Policy Update: Vitiligo

horizonbcbsnj — Mon, 25 Nov 2019 20:27:41 +0000

Medical Policy Update: Vitiligo Mon, 11/25/2019 - 15:27

Effective December 31, 2019, Horizon BCBSNJ will change the way we consider certain professional claims for services provided to Horizon BCBSNJ Medicare Advantage (MA) plans based on updates to our medical policy, Vitiligo.

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided on and after December 31, 2019 to patients enrolled in Horizon BCBSNJ MA plans will be processed as follows.

Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by CPT® codes 96920, 96921 and 96922. Following our review of medical record information, these services may be denied as not medically necessary.

CPT® is a registered mark of the American Medical Association.

¹ The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.

Medical Policy Update: Phototherapy for Psoriasis

horizonbcbsnj — Mon, 25 Nov 2019 19:22:20 +0000

Medical Policy Update: Phototherapy for Psoriasis Mon, 11/25/2019 - 14:22

Effective December 31, 2019, Horizon BCBSNJ will change the way we consider certain professional claims for services provided to Horizon BCBSNJ Medicare Advantage (MA) plans based on updates to our medical policy, Phototherapy for Psoriasis.

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided on and after December 31, 2019 to patients enrolled in Horizon BCBSNJ MA plans will be processed as follows.

Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by CPT® codes 96920, 96921 and 96922. Following our review of medical record information, these services may be denied as not medically necessary.

CPT® is a registered mark of the American Medical Association.

Medical Policy Revision: Gait Trainers and Standing Frames

horizonbcbsnj — Mon, 25 Nov 2019 07:55:45 +0000

Medical Policy Revision: Gait Trainers and Standing Frames Mon, 11/25/2019 - 02:55

Effective February 27, 2020, Horizon BCBSNJ will change the way we consider certain claims for gait trainers and standing devices.

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided on and after February 27, 2020 to patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO), or Medicare Advantage (MA) plans will be processed as follows.

Based on the submitted diagnosis codes, information may be requested to help us determine the medical appropriateness of the services represented by HCPCS codes E8000, E8001, E8002 and/or E0638. Following our review of medical record information, these services may be denied as not medically necessary.

¹ The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.

Gait Trainers and Standing Frames

horizonbcbsnj — Thu, 21 Nov 2019 19:17:03 +0000

Gait Trainers and Standing Frames Thu, 11/21/2019 - 14:17

Medical policy type

Revised

Third Party URL

https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/RFMI-AFCGX5

Have a billing question? We’re here for you.

horizonbcbsnj — Wed, 20 Nov 2019 09:09:51 +0000

Have a billing question? We’re here for you. Wed, 11/20/2019 - 04:09

If you bought your coverage directly from Horizon BCBSNJ or through the Exchange and need help with your premium bill, we’re here to help.

Call 1-800-355-BLUE (2583) to speak with a Member Services Representative during our extended hours:

Weekdays from December 2, 2019 through Friday, January 31, 2020, from 8 a.m. to 7:30 p.m., Eastern Time (ET), except as noted below
Saturdays, from November 30, 2019 through February 1, 2020, 9 a.m. to 3 p.m., ET
Sunday, December 15 from 10 a.m. to 2 p.m., ET
Tuesday, December 24 from 9 a.m. to 3 p.m., ET
Wednesday, January 1 from 9 a.m. to 3 p.m., ET
Monday, January 20 from 9 a.m. to 5 p.m., ET

Learn more about how to make a premium payment.

Have claims or benefits questions?
Our Member Services Representatives are available during regularly scheduled hours – Mondays, Tuesdays, Wednesdays and Fridays, between 8 a.m. and 6 p.m., ET, and Thursdays, between 9 a.m. and 6 p.m., ET.

You can also sign in to the Horizon Blue app or our secure member web portal at HorizonBlue.com to read our FAQs, send an email or Chat. To get the app, text GetApp to 422-272 or download it from the App Store® or Google PlayTM.

Apple® and the Apple logo are trademarks, and App Store® is a service mark of Apple, Inc. Google Play™ is a trademark of Google, LLC. There is no charge to download the app, but rates from your wireless provider may apply.

Our Population Health Management Strategy

horizonbcbsnj — Tue, 19 Nov 2019 07:58:40 +0000

Our Population Health Management Strategy Tue, 11/19/2019 - 02:58

This document details Horizon Blue Cross Blue Shield of New Jersey’s strategy for managing the health of our members. It includes an overview of the services we have to improve the quality of care our members receive.

HorizonBCBSNJ PHM Strategy

Member Portal Maintenance

horizonbcbsnj — Mon, 18 Nov 2019 16:54:37 +0000

Member Portal Maintenance Mon, 11/18/2019 - 11:54

Horizon BCBSNJ's Member Portal will undergo scheduled maintenance beginning at 8 p.m. November 22, 2019 until 8 a.m. November 25, 2019. We apologize for the inconvenience and appreciate your patience.

MOBE ® to Offer Personalized Health Services to Select Members

horizonbcbsnj — Mon, 18 Nov 2019 14:53:11 +0000

MOBE ® to Offer Personalized Health Services to Select Members Mon, 11/18/2019 - 09:53

Horizon BCBSNJ is working with MOBE, an independent company, to offer select members personalized health services and coaching – at no additional cost. MOBE helps educate participants on the importance of lifestyle choices and self-advocacy as critical components for improving health.

If your patients are eligible to receive these voluntary services, MOBE will contact them by mail, email or phone.

What’s included?
Eligible members receive information, guidance and support to help them feel their best. Services include:

Being paired with a “MOBE Guide,” a health coach who will work with members through one-on-one conversations by phone or through the MOBE Health Guide app.
Guidance to improve overall quality of life by addressing sleep habits, nutrition, exercise and stress management.
Access to pharmacists to discuss medications to optimize effectiveness.

A MOBE pharmacist may contact you about your patients’ medications.

Visit MOBE to learn more.

MOBE® is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey with guided health solutions. MOBE is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.

Personalized Health Services to be Offered to Select Members

horizonbcbsnj — Wed, 13 Nov 2019 07:09:57 +0000

Personalized Health Services to be Offered to Select Members Wed, 11/13/2019 - 02:09

Select members with unique health goals and challenges may be eligible to receive personalized health services and coaching – at no additional cost.

Horizon BCBSNJ is working with MOBE®, an independent company, to offer these services as part of eligible members’ Horizon BCBSNJ coverage.

What’s included?
Eligible members receive information, guidance and support to help them feel their best. Services include:

Being paired with a “MOBE Guide,” a health coach who will work with members through one-on-one conversations by phone or through the MOBE Health Guide app.
Guidance to improve overall quality of life by addressing sleep habits, nutrition, exercise and stress management.
Access to pharmacists to discuss medications to optimize effectiveness.

What happens next?
If you are eligible to receive these voluntary services, MOBE will contact you with information by mail, email or phone. You can choose to be paired with a MOBE Guide and arrange to set up your first phone call.

Visit MOBE to learn more.

Get the Flu Shot. Not the Flu.

horizonbcbsnj — Mon, 11 Nov 2019 09:34:32 +0000

Get the Flu Shot. Not the Flu. Mon, 11/11/2019 - 04:34

At Horizon Blue Cross Blue Shield of New Jersey, we work hard to ensure that our members have access to the preventive care services they need.

According to preliminary new data from the Centers for Disease Control and Prevention (CDC), an estimated 80,000 Americans died of the flu and its complications during the 2019-2020 flu season. It was the deadliest flu season in more than 40 years.

Flu shots are an important step in preventing illnesses and staying healthy.

The CDC recommends a yearly flu vaccine for everyone 6 months of age and older as the first and most important step in protecting against this serious disease.

The flu season typically peaks December through February but can last until May, and it usually takes about two weeks for the shot’s immunity to kick in. Protecting yourself from flu also helps protect the people around you.

Benefits of the Flu Shot

The Flu vaccine:

Can keep you from getting sick with the flu;
Can reduce the risk of flu-associated hospitalization;
Is an important preventive tool for people with chronic health conditions;
Reduces the severity of illness in people who get vaccinated but still get sick with the flu.

In addition to getting the flu shot, it is important to practice good health habits such as regular hand washing, especially before eating, and limiting contact with others when you or they are sick.

Learn which pharmacies can administer flu shots and other vaccines.

Understanding Pharmacy Benefits

horizonbcbsnj — Mon, 11 Nov 2019 08:25:13 +0000

Understanding Pharmacy Benefits Mon, 11/11/2019 - 03:25

Learn more about the ins and outs of your prescription drug coverage.

Part D Prescription Drug Coverage

Medicare Part D coverage is optional. It provides benefits to help you pay for your prescription medicines.

Learn about what your plan pays and what you pay for your prescription medicines.

Understanding Medicare Part D

View Transcript

When it comes to your health insurance coverage, you have a lot of choices. But did you know that Original Medicare does not cover prescriptions? That’s why a Horizon Medicare Advantage plan gives you the peace of mind that you have prescription coverage. This is also known as Medicare Part D.

It’s important that you understand how prescription drug coverage works, including how much you’ll pay for medicines, so you can get the most from your plan.

There are four stages that make up Part D coverage. These stages determine how much your plan pays and the amount you’ll be responsible to pay out of pocket for your prescription medicines.

Remember to review your Explanation of Benefits statement that’s sent to you each month. Your coverage stage is in section two of the statement.

The dollar amounts included in this video are only examples to help you understand how coverage stages work. Your actual amounts may be different depending on your Horizon Medicare Advantage plan.

The first stage is the Deductible Stage. A deductible is the total amount you must pay out of pocket for your medicines before your insurance begins to pay.

Your deductible must be met each year. Once you meet your deductible, you’ll move into the Initial Coverage Stage. This means you’ll only pay the copayment or coinsurance – depending on the medicine. Your Horizon Medicare Advantage plan will pay the rest of the eligible cost for any covered medicine.

Your total drug cost – what you and your plan have paid for your medicines – add up during the Coverage stage.

Once you meet a specific dollar amount for the year, you’ll move into the Coverage Gap Stage, also known as the donut hole. You generally pay more for medicines during this stage.

So, how do you get there? Let’s take a look at an example of medicine that costs $100. If your copayment is $10 and your plan pays the remaining $90, the total cost of $100 is the amount that goes toward the Coverage Gap Stage. So, if you take more than one medicine, you may reach this stage quickly.

The good news is that during this stage, you only pay a percentage of the cost of the drug.

However, both your monthly premium and the amount paid for medicines not covered by your Horizon Medicare Advantage plan do not count towards the coverage gap total.

Once in the donut hole, you get a 70 percent manufacturer’s discount on covered brand name medicines and your plan pays an additional 5 percent. This means you’ll only have to pay 25 percent of the agreed cost of a brand name medicine. And, you can save more by getting generic medicines.

Once you have paid the maximum out-of-pocket costs set by Medicare, you will move to the Catastrophic Coverage Stage. You’ll then pay less for covered medicines for the rest of the year.

Making sense of Part D can be complicated. We want to make it easy.

At Horizon Blue Cross Blue Shield of New Jersey, we want to help you understand your choices on your journey to better health.

ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-365-2223 (TTY 711).

ATENCIÓN: Si habla otro idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-365-2223 (TTY 711).

Horizon Insurance Company (“HIC”) has a Medicare contract to offer HMO, HMO-POS, PPO and Part D Medicare plans, including group-Medicare Advantage plans and group Part D Prescription Drug plans. Enrollment in HIC Medicare products depends on contract renewal. Products are provided by HIC. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2019 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105.

Learn how to save money on your medicines.

Save Money on Your Prescription Medications

View Transcript

Prescription medications can cost a lot, especially if you take them on a regular basis.

If you qualify for Medicare, then you also qualify for prescription drug coverage, commonly known as Medicare Part D. Part D helps cover some of the cost of your prescription medications.

Even if you’re not taking prescription medications now, it’s a good idea to have coverage in place, in case your needs change in the future.

You can add a Medicare Prescription Drug Plan - Part D - to your Original Medicare coverage or you can enroll in a Medicare Advantage plan - Part C - that includes prescription drug coverage.

These plans are offered by private insurance companies like Horizon Blue Cross Blue Shield of New Jersey.

Horizon’s prescription drug coverage helps you pay less for your prescription medications.

Our prescription drug coverage includes zero dollar deductibles with certain Medicare Advantage plans and PDP enhanced plans; copays as little as one dollar for preferred generic prescription drugs when you use one of our preferred pharmacies; the convenience of 90-day, mail-order prescriptions delivered right to your home; an extensive list of covered prescription medications, both generic and brand-name; and a network of more than 1,500 pharmacies, including many popular retail pharmacies like CVS and Walmart.

Remember, you can save money by having your doctor prescribe generic drugs. The Federal Drug Administration ensures that generic medications are as safe and effective as their brand-name counterparts. That means you can significantly save on your prescription medications, without sacrificing quality or safety.

With Horizon’s Medicare prescription drug coverage, we make it more affordable for you to get the prescription medications you need.

At Horizon Blue Cross Blue Shield of New Jersey, we want to help you understand your choices on your journey to better health.

ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-365-2223 (TTY 711).

ATENCIÓN: Si habla otro idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-365-2223 (TTY 711).

Helpful Tips to Keep You on Track with Your Medicines

Home Delivery Pharmacy Service

Understanding your pharmacy benefits through Horizon Blue Cross Blue Shield of New Jersey can help save you time and money. Horizon Medicare Advantage members use AllianceRx Walgreens Prime for convenient home delivery pharmacy service.

Home delivery pharmacy service is safe, convenient and could save you money:

No more waiting in line at the pharmacy
A record of your medications is always available
With 90-day supplies, you could have fewer copayments
Free standard shipping, refill reminders and an auto-refill program
Delivery anywhere in the United States, even when you’re away from home
Medicines shipped in tamper-evident containers and delivered in plain packaging for privacy

A licensed pharmacist always processes your order and you can speak with the pharmacy team any time.

To start using the home delivery pharmacy service, visit alliancerxwp.com/home-delivery and follow the instructions to create an account. Once you’ve created an account, you can ask your doctor to send your prescription electronically to AllianceRx Walgreens Prime, or fax a prescription request to 1-800-332-9581.

No-Cost Flu Shots and Other Immunizations

horizonbcbsnj — Mon, 11 Nov 2019 07:34:18 +0000

No-Cost Flu Shots and Other Immunizations Mon, 11/11/2019 - 02:34

October 14, 2019

Applies to: Fully insured and self-insured groups with Horizon BCBSNJ medical benefits (excluding Medicare Advantage)

Immunizations are an important step in preventing illnesses and staying healthy, and they are a covered service under members’ medical benefits – this includes no-cost flu shots.

To provide greater access to immunizations, Horizon Blue Cross Blue Shield of New Jersey’s in-state immunization network includes pharmacies in our medical network. These pharmacies can administer vaccines throughout the year, including flu, shingles, hepatitis A and B, pneumococcal, human papillomavirus (HPV), tetanus and measles-mumps-rubella (MMR). These pharmacies will also submit medical claims for these services.

The New Jersey locations of the participating pharmacies listed below can administer vaccines:

Pharmacy	Location
ACME	Locate ACME Savon Pharmacies at http://www.acmemarkets.com
CVS	Locate CVS pharmacies at cvs.com
Park Plaza Pharmacy	343 State Route 34, Matawan, NJ 07747; 1-732-290-9111
Rite Aid	Locate Rite Aid pharmacies at riteaid.com
ShopRite	Locate ShopRite pharmacies at shoprite.com
Walgreens	Locate Walgreens pharmacies at walgreens.com

A listing of Independent New Jersey pharmacies that can administer no-cost flu shots and other vaccines, including shingles, hepatitis A and B, pneumococcal and human papillomavirus1 (HPV) for members with medical coverage through Horizon BCBSNJ is also available.

View answers to frequently asked questions on Horizon BCBSNJ’s in-state immunization network.

Please communicate this with employees. Your employees can also visit HorizonBlue.com/flu.

If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.

List - Flexible Spending Account - Dependent Expenses

horizonbcbsnj — Mon, 04 Nov 2019 10:57:46 +0000

List - Flexible Spending Account - Dependent Expenses Mon, 11/04/2019 - 05:57

Attachment

EC00750_Dependent_Care_FSA_Eligible_Expenses_0.pdf