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New UNITE HERE HEALTH Groups Effective June 1

horizonbcbsnj — Thu, 04 Jun 2020 16:00:27 +0000

New UNITE HERE HEALTH Groups Effective June 1 Thu, 06/04/2020 - 12:00

Horizon BCBSNJ is pleased to advise that we now provide health insurance coverage to Food Service Plan (FSP) 176 and Food Service Plan (FSP) 376 within UNITE HERE HEALTH (UHH), a multi-employer benefit trust fund serving the hospitality, food service and gaming industries.

Effective June 1, 2020, these groups (previously enrolled in plans provided by Blue Cross Blue Shield of Illinois) are enrolled in the Horizon BCBSNJ plans noted below.

Group Name	Group #	Horizon BCBSNJ plan	ID Card Prefix
Food Service Plan 176	76305	Horizon Direct Access	F5Z
Food Service Plan 176	76306	Horizon PPO	H7B
Food Service Plan 376	76275	Horizon Direct Access	F4S
Food Service Plan 376	76307	Horizon PPO	H7P

Members who live outside of New Jersey are enrolled in Horizon PPO plans and access their network benefits when they visit providers participating in our broad Horizon PPO Network. Members who live in New Jersey are enrolled in Horizon Direct Access plans and may (but are not required to) choose a Primary Care Physician (PCP) to coordinate his or her care. Both plans include coverage outside our local service area through the BlueCard® PPO program.

For information about UNITE HERE HEALTH member benefits, please access the Benefits & Eligibility tool within NaviNet or call Physician Services at 1-800-624-1110 or our Centralized Service Center at 1-888-666-2535.

PRIOR AUTHORIZATION LISTS
The prior authorization requirements for these new UHH groups (76305, 76306, 76275 and 76307) vary from our other enrolled UHH groups.

To access the list of services/procedures that require prior authorization for these new UHH members, please visit Services Requiring Prior Authorization, select click UNITE HERE HEALTH and select the appropriate UHH group.

We encourage all providers to review this information to ensure that prior authorization is obtained where necessary to avoid delays in claim processing.

The prior authorization list for members in UHH groups 76215 and 76141 was also updated as follows:

Medical Cost Management Corporation (1-800-367-9938) performs PA for habilitative therapy for children with autism spectrum disorder (ABA therapy).

SUBMITTING PRIOR AUTHORIZATION REQUESTS
Most prior authorization requests can be submitted online. Simply log into NaviNet.net, access our Plan Central page and select Referrals and Authorization, then Utilization Management Requests.

As noted on the online PA list, certain services to be provided to FSP 376 & FSP 176 members require prior authorization through business partners working on our behalf, including:

eviCore healthcare performs PA for the following services as part of our existing programs

CareCentrix performs PA for the following services as part of our Horizon Care@Home program.

Durable Medical Equipment (DME), Home Health Care Services, Home Hospice Services, Home Infusion Services, Prosthetics/Orthotics, Medical Foods

Medical Cost Management Corporation performs PA for habilitative therapy for children with autism spectrum
disorder (ABA therapy).

Magellan Rx Management performs PA for Specialty Pharmaceuticals/Medical Injectable Drugs through
our Medical Injectables Program

Committed to advance the causes of equality and justice

horizonbcbsnj — Thu, 04 Jun 2020 15:56:56 +0000

Committed to advance the causes of equality and justice Thu, 06/04/2020 - 11:56

Please read this important message from President and CEO Gary D. St. Hilaire.

VRI Program ending June 30, 2020

horizonbcbsnj — Fri, 29 May 2020 14:08:55 +0000

VRI Program ending June 30, 2020 Fri, 05/29/2020 - 10:08

Some providers may have patients that are currently participating in the vitals home-monitoring program with Valued Relationships, Inc. (VRI). Unfortunately, Horizon Blue Cross Blue Shield of New Jersey’s (Horizon BCBSNJ) participation with this program is ending on June 30, 2020.

Patients who are impacted will be notified and will receive instructions on how to return the necessary equipment. A VRI representative may also contact you with additional information. You will continue to receive alerts from VRI until June 30, 2020.

If you have any questions about this program, please call us:

Horizon BCBSNJ Medicare Advantage providers: 1-800-624-1110
Horizon NJ Health and Horizon NJ TotalCare (HMO D-SNP) providers: 1-800-682-9091

Thank you for your continued commitment to your patients, especially during these difficult times.

More products are now eligible for reimbursement through your Health Savings Account (HSA) and Flexible Spending Account (FSA)

horizonbcbsnj — Fri, 29 May 2020 01:42:39 +0000

More products are now eligible for reimbursement through your Health Savings Account (HSA) and Flexible Spending Account (FSA) Thu, 05/28/2020 - 21:42

On March 27, 2020, the CARES Act was signed into law expanding the list of products eligible for reimbursement from your medical Health Savings Account (HSA) and Flexible Spending Account (FSA). Some items may also be newly eligible for Health Reimbursement Arrangement (HRA) plans.

Eligible items now include:

Over-the-counter (OTC) medicines, which previously were only eligible for reimbursement with a prescription
Feminine hygiene products such as tampons, pads, liners, cups and sponges

This change is retroactive to January 1, 2020. This means you can file for reimbursement for these items if you’ve purchased them since January 1.

How to take advantage of the changes

It’s easy—just continue to use your debit card as you would for any eligible item.

If your debit card doesn’t work, it may be that the store’s system hasn’t been updated. If that happens, use another form of payment for the items and submit your receipt for reimbursement. You can submit for reimbursement through HorizonBlue.com, the Horizon Blue app, or by faxing or mailing.

Sign in at HorizonBlue.comand then under the My Accounts section, select Horizon MyWay. Click on View More Activity. Under the I Want To section, select Get Reimbursed.

Horizon Blue app

To access your Horizon MyWay account(s) through the Horizon Blue app, simply:

Download and sign in to the Horizon Blue app.
Scroll down and tap My Accounts – Out of pocket & spending accounts.
Tap Horizon MyWay

How to submit claims

Fax to 1-866-231-0214
Mail to:

Horizon BCBSNJ FSA
PO Box 64193
St. Paul, MN 55164-019

Prior Authorization Requirements for UHH Group #s 76275 & 76307 (Food Service Plan 376), and UHH Group #s 76305 & 76306 (Food Service Plan 176)

horizonbcbsnj — Thu, 28 May 2020 17:51:32 +0000

Prior Authorization Requirements for UHH Group #s 76275 & 76307 (Food Service Plan 376), and UHH Group #s 76305 & 76306 (Food Service Plan 176) Thu, 05/28/2020 - 13:51

The procedures/services outlined here require prior authorization.
This list was revised on June 1, 2020 and may be subject to change.

All Inpatient Admissions
- surgical admissions
- medical admissions
- hospice admissions (exclusive of maternity delivery)
- rehabilitation facility admissions (acute rehab, skilled nursing and sub-acute
- mental health and substance abuse admissions
Air Ambulance transportation - NON EMERGENT
Bariatric or Gastric Bypass Procedures -Surgery for Morbid Obesity, including but not limited to Bariatric Procedures, Gastroplasty, Gastric Bypass - outpatient
Cardiac Radiology Services - Non Emergent Only
Please note that only the following Cardiology Imaging Services require prior authorization by eviCore healthcare for these members
- Stress testing (Myocardial perfusion imaging [SPECT and PET], Stress echocardiography)
- Cardiac CT and MRI
- Echocardiography: transthoracic and transesophageal
- Diagnostic heart catheterization
Visit the Cardiology Imaging Program webpage or call eviCore healthcare at 1-866-496-6200.
Clinical Trials
Cosmetic procedures and potentially cosmetic procedures including but not limited to cosmetic dermatology services; varicose vein procedures
Durable Medical Equipment (DME) - Certain DME items costing over $500
Visit the Horizon Care@Home webpage or call CareCentrix at 1-855-243-3321.
Gender Reassignment
Habilitative therapy for children with autism spectrum disorder (ABA therapy).
Please call Medical Cost Management Corporation at 1-800-367-9938.
Home Health Care Services – all skilled services in the home
Home Hospice Services
Home Infusion Services
Visit the Horizon Care@Home webpage or call CareCentrix at 1-855-243-3321.
Hyberbaric oxygen therapy
Medical Foods
Mental health and Substance Abuse Services
- Inpatient (IP)
- Inpatient Detox
- Residential (RTC)
- 23hr bed
- 72hr bed
- Partial Hospitalization (PHP)
- Intensive Outpatient (IOP)
- Psychological Testing
- In Home Services
- Electroconvulsive Therapy (ECT)
- Transcranial Magnetic Stimulation (TMS)
Molecular and Genomic Testing services
Visit the Molecular and Genomic Testing Program webpage or call eviCore healthcare at 1-866-496-6200.
Prosthetics/Orthotics - over $500
Visit the Horizon Care@Home webpage or call CareCentrix at 1-855-243-3321.
Radiation Therapy services
Visit the Radiation Therapy Program webpage or call eviCore healthcare at 1-844-224-0493.
Radiology/Imaging Services including but not necessarily limited to:
- Magnetic Resonance Imaging (MRI)
- Magnetic Resonance Angiograms (MRAs)
- Positron Emission Tomography (PET) scans
- Positron Emission Tomography – Computed Tomography (PET-CT)
- Computerized Tomography (CT) scans
- Computed Tomography Angiography (CTA) scans
- Nuclear Medicine
- Nuclear Cardiac Imaging
Visit the Radiology/Imaging Services webpage or call eviCore healthcare at 1-866-496-6200.
Specialty Pharmaceuticals/Medical Injectable Drugs (e.g. Botox, IVIG, Flolan and derivates; Xolair)
Visit the Medical Injectables Program webpage or call Magellan Rx Management at 1-800-424-4508.
Transplant Services except Corneal Transplants (Case Management)
Travel and Lodging benefits Call UNITE HERE HEALTH at 1-833-637-3519.

Prior Authorization Requirements for UHH Group #76141(Atlantic City) and UHH Group #76215 (New York)

horizonbcbsnj — Thu, 28 May 2020 17:05:02 +0000

Prior Authorization Requirements for UHH Group #76141(Atlantic City) and UHH Group #76215 (New York) Thu, 05/28/2020 - 13:05

The procedures/services outlined here require prior authorization.
This list was revised on June 1, 2020 and may be subject to change.

Please note that UNITE HERE HEALTH (Local 54) uses eviCore healthcare to perform prior authorization reviews for advanced radiology/imaging/cardiology services (including echocardiograms) and for radiation therapy. Additional information about eviCore healthcare and the services that require prior authorization through eviCore healthcare may be obtained online.

The Medical Injectables Program is administered through Magellan Rx Management. Additional information about Magellan Rx Management and the list of injectable medications under the program may be obtained online or call 1-800-424-4508, Monday through Friday, between 8 a.m. and 5 p.m., ET.

All Inpatient Admissions
All elective acute care, exclusive of maternities (routine maternity admissions are excluded from prior authorization), including:
- Elective surgical admissions
- Elective medical admissions
- Elective C-section admissions under 38 weeks gestation.
- Hospice admissions
- All rehabilitation facility admissions including acute rehab, skilled nursing facility (SNF) and sub-acute admissions
- Mental health and substance abuse admissions. Prior authorization performed by Optum; call 1-866-248-4094
  **Routine maternity admissions are excluded from prior authorization requirement; NOA required**
  **NonElective Admission including ER Admissions require Notification of Admission (NOA)**
ABA Therapy (Call Medical Cost Management Corporation at 1-800-367-9938 )
Ambulance transportation – non-emergent – ground or air
Arthroscopy, regardless of setting
Bariatric services including gastric bypass and banding procedures
Blepharoplasty
Cardiac radiology services (non emergent) (prior authorization performed by eviCore healthcare)
Including Non-emergent diagnostic cardiac catheterization/echo stress test
Carpal tunnel release
Clinical Trials – all
Cochlear implants
Durable medical equipment (DME) exceeding $500 (Where the total anticipated cost or rental charge exceeds $500)
Echocardiograms (prior authorization performed by eviCore healthcare)
Electromyogram (EMG)
Excision of excessive skin – e.g. due to weight loss
Gender reassignment surgery (Call UNITE HERE HEALTH at 1-888-437-3480)
Genetic testing
Gynecomastia – surgical treatment
Habilitative therapy for children with autism spectrum disorder (ABA therapy)
(Call Medical Cost Management Corporation at 1-800-367-9938)
Hip replacement
Home health care services – all skilled visits in the home
Home IV infusion therapy/services
Hormone therapy related to gender reassignment surgery (Call UNITE HERE HEALTH at 1-888-437-3480)
Hospice care services
Hyperbaric oxygen therapy
Knee replacement
Laminectomy
Lipectomy or removal of excessive fat/tissue
Mammoplasty (breast reduction)
Medical foods for inborn errors of metabolism
Meniscectomy
Myelogram
Occupational therapy
Orthognathic jaw surgery including treatment for temporomandibular joint disorder (TMJ) and other craniofacial disorders
Orthotics (including podiatric orthotics) over $500
Out-of-network requests for consideration of in-network level of benefit when network deficiency exists (Notify UNITE HERE HEALTH of all such requests)
Outpatient surgery performed in a hospital-based site of service
Percutaneous discectomy reduction
Physical therapy – outpatient services and home health visits
202 only: podiatric services (All non-routine services)
Prosthetics over $500
Radiation Therapy (prior authorization performed by eviCore healthcare)
Radiology (prior authorization performed by eviCore healthcare)
- Cardiac CT scans
- CT and CTA scans
- Echocardiogram
- MRI
- MRA
- Nuclear medicine/nuclear cardiology
- PET and PET/CT scans
Rhinoplasty/septoplasty
Sclerotherapy or surgery for varicose veins
Sleep studies
Speech therapy
Submucous resection
Transplant services
Travel and lodging benefits (Call UNITE HERE HEALTH at 1-888-437-3480)
Uvulopalatopharyngoplasty (UPPP)

THERE IS NO PRIVATE DUTY NURSING BENEFIT

Horizon BCBSNJ has a number of specialized service areas that provide more specific information and assistance with authorizations and pre-certification. In order for these specialized service areas to perform their functions efficiently and effectively, please seek basic benefits, enrollment and eligibility information prior to contacting our Prior Authorization Department for an authorization request. If you require documentation that a service does not require pre-certification, a Physician Services Representative can provide both the information you need and a service reference number that documents the information you were provided.

BlueCard®/Out-of-state authorizations
1-888-621-5894
BlueCard®/Out-of-state members (eligibility and benefits)
1-800-676-BLUE(2583)
eviCore healthcare (prior authorization/medical necessity determinations)
Phone: 1-866-496-6200
Fax: 1-800-637-5204 (radiology services); 1-888-785-2480 (cardiology services)
Home care and/or Home IV infusion
1-800-492-2580 (fax)
Notices of admission for out-of-state and non-network facilities
1-888-621-5894
Optum (Mental health and substance abuse admissions and non-routine outpatient care, including: intensive outpatient programs, partial hospitalization programs, electro-convulsive treatment, psychological testing, methadone maintenance, extended outpatient visits greater than 53 minutes, and transcranial magnetic stimulation) 1-866-248-4094
Physical Therapy: Prior authorization can be obtained online. Simply log into NaviNet.net, access our Plan Central page and select Physical and Occupational Therapy Authorizations. The first 12 visits are usually authorized after a claim is received.
Prior-authorization requests: Most PAs can be requested online. Simply log into NaviNet.net, access our Plan Central page and select Referrals and Authorization, then Utilization Management Requests. You may also call 1-800-664-2583.

Helping patients with maternal mental health

horizonbcbsnj — Wed, 27 May 2020 17:34:47 +0000

Helping patients with maternal mental health Wed, 05/27/2020 - 13:34

May is Maternal Mental Health Awareness Month. Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) offers resources to help you manage your patients’ depression and anxiety before, during and after a pregnancy.

All parents are facing new challenges in the current reality. For expectant and new parents, the stress and anxiety may be higher as they focus on caring for their child. As a result, they may require additional support as they navigate pregnancy and caring for a newborn, and are more likely to underestimate the impact pregnancy has on their mental health.

Up to 20 percent of women develop a mood disorder before and after giving birth.¹ Assessing for depression and addressing your patients’ concerns during pregnancy and postpartum is critical to overall patient care, including the new parent’s ability to care for their newborn.

If you or your patients have questions about accessing behavioral health care or would like information on the support programs we offer our members, call our dedicated Horizon Behavioral Health℠ team at 1-800-626-2212, 24/7.

Additional Resources:

Maternal Mental Health
Maternal Health Task Force at Harvard University
Pregnancy and Postpartum Disorders

¹NJ.gov

Dates for Certain Prior Authorization Waivers Further Extended

horizonbcbsnj — Wed, 27 May 2020 16:13:33 +0000

Dates for Certain Prior Authorization Waivers Further Extended Wed, 05/27/2020 - 12:13

Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions

Horizon BCBSNJ has waived precertification/prior authorization requirements for inpatient admissions on or prior to June 14, 2020. These changes are for all Horizon BCBSNJ members, including those covered through Medicaid, Medicare, fully insured and self-insured policies. These changes apply to all inpatient admissions at acute care facilities

Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility Admissions

The change is effective immediately for Horizon BCBSNJ members, including those covered through Medicaid, Medicare Advantage, FIDE-SNP, fully insured and self-insured policies. This does not apply to Federal Employee Program® (FEP®) members.

Effective immediately and through June 14, 2020, Horizon BCBSNJ has extended the waiver for post-acute facility inpatient authorization requirements for admissions to Skilled Nursing, Subacute Physical Rehabilitation and Inpatient Acute Physical Rehabilitation facilities for admissions prior to or on June 14, 2020. This change does not apply to Long Term Acute Care Hospitals (LTACHs).

The following will take effect for admissions to post-acute facilities prior to or on June 14, 2020:

The Notice of Admission can be submitted by the post-acute facility, hospital or health care professional via our online Utilization Management Request Tool accessed on NaviNet®, phone or fax as noted below.
Please include a diagnosis when submitting a request, especially if it is a COVID-19 diagnosis.
Clinical review for the admission will be waived.
Out-of-network receiving facilities should notify Horizon BCBSNJ of the admission. Out-of-network facilities will be paid per the terms of the applicable benefit plan or the agreed-upon rate.
Update: When you have a patient in a post-acute facility for longer than 14 days, concurrent review will be applied.

Contact Information for all Post-Acute Facility Requests:

Horizon NJ Health Members

Phone: 1-800-682-9094, Ext. 89104
Fax: 1-973-274-3867

Medicare Advantage & FIDE-SNP Members

Phone: 1-844-884-2423 (naviHealth)
Fax: 1-866-683-5009

Horizon BCBSNJ Commercial Members

Submit PAFs via our online Utilization Management Request Tool accessed on NaviNet.
Phone: 1-844-243-3450

Waiving Authorizations for Oxygen Following ER Discharge

To help hospitals treat patients efficiently during the COVID-19 public health emergency, authorization for supplemental oxygen (O2) for all patients who are discharged from the Emergency Room (ER) is not required for a period of 30 days. This change is effective until June 30, 2020.

Sacituzumab govitecan-hziy (Trodelvy)

horizonbcbsnj — Wed, 27 May 2020 11:59:56 +0000

Sacituzumab govitecan-hziy (Trodelvy) Wed, 05/27/2020 - 07:59

Medical policy type

New

Third Party URL

https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/SSHH-BPDQS4

Mitomycin for Pyelocalyceal Solution (Jelmyto)

horizonbcbsnj — Wed, 27 May 2020 11:55:45 +0000

Mitomycin for Pyelocalyceal Solution (Jelmyto) Wed, 05/27/2020 - 07:55

Medical policy type

New

Third Party URL

https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/SSHH-BPEMVH

How to beat back pain

horizonbcbsnj — Tue, 26 May 2020 06:16:35 +0000

How to beat back pain Tue, 05/26/2020 - 02:16

About 80% of adults experience low back pain at some point in their lifetimes. And when back pain strikes, it can leave you, well, flat on your back. Maybe it came on suddenly because you lifted something heavy. Or you’ve been sitting more than usual and you’re stiff and sore. If you have back pain, here are some common treatments you can try. Speak with your doctor about which treatment may be right for you.

Rest first, but then get moving. Resting can help a recent injury or strain that causes back pain. But staying in bed a day or two can actually make back pain worse. The best thing for your back is gentle exercise, such as walking or stretching. Try to get moving as soon as you can.

Use over-the-counter (OTC) and prescription medicine — with caution. Medicine, such as OTC pain relievers, prescription muscle relaxants and narcotics can reduce pain and inflammation. But even OTC medicines have side effects. And long-term use or misuse of prescription opioids can lead to dependency. Because pain killers mask your pain, they can also make it hard to get to the cause of your pain.

Consider complementary or alternative care. Chiropractic treatment and acupuncture are two non-surgical, non-traditional medical therapies that may help. Chiropractic treatment is based on the theory that proper alignment of the body’s musculoskeletal structure will enable the body to heal itself. Acupuncture is an ancient practice that involves placing thin needles in specific areas of the body to help with pain relief.

Get physical therapy. Physical therapists (PTs) look at your physical needs and guide your therapy to help you move and function better. Treatment may include exercises or stretches guided by your therapist, massage, heat or cold therapy, or ultrasound to ease muscle pain or spasms.

Sources: webmd.com; mayoclinic.org; National Institutes of Neurological Disorders and Stroke.

Molecular and Genomic Testing Program Update: July 2020

horizonbcbsnj — Mon, 25 May 2020 07:52:15 +0000

Molecular and Genomic Testing Program Update: July 2020 Mon, 05/25/2020 - 03:52

Horizon BCBSNJ 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.

For services to be rendered on and after July 1, 2020 in a physician’s office or clinical laboratory¹, eviCore will conduct pre-service Medical Necessity Determination (MND) reviews of the services represented by the following Proprietary Laboratory Analyses (PLA) codes:

0172U
0173U
0175U
0179U

Review the complete list of molecular and genomic diagnostic testing services subject to MND review as part of this program or review more details about our Molecular and Genomic Testing Program.

If you have questions, please contact your Network Specialist or Ancillary Contracting Specialist.

¹ MND 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.

Remote Patient Monitoring for COPD

horizonbcbsnj — Wed, 20 May 2020 06:22:57 +0000

Remote Patient Monitoring for COPD Wed, 05/20/2020 - 02:22

New program provides free remote patient monitoring

Tracking and monitoring daily symptoms such as cough, wheezing and shortness of breath is key to properly managing Chronic Obstructive Pulmonary Disease (COPD). With this information, you and your doctors can respond early to changes, which can mean fewer trips to the Emergency Room (ER) or hospital.

To help make managing COPD easier for you, Horizon BCBSNJ is working with HGE Health to administer a Chronic Obstructive Pulmonary Disease (COPD) Remote Patient Monitoring program. This program uses a clinically validated digital platform and technology-enabled services called HGE Care™.

How does it work?

Members log their daily COPD symptoms using a digital health app, by visiting HGE online, or by calling HGE. When reported symptoms reveal a change from what’s typical for the member, a team of registered nurses coordinates care so the member’s primary care or pulmonary doctor can take early steps to address worsening symptoms.

Am I eligible?

To find out if you’re eligible, or to join, call 1-877-709-0995. Representatives are available seven days a week, including holidays and weekends, from 8 a.m. to 8 p.m., Eastern Time.

You may also receive a letter from your doctor if you are eligible for this program.

For questions about benefits and coverage, call the Member Services number located on the back of your Horizon BCBSNJ member ID card, or sign in to Chat with a Member Services representative.

What do members receive?

Through this program, eligible members have:

Access to a digital health app for logging daily respiratory symptoms and tracking changes
An enrollment session to teach members how to assess and report daily symptoms
Access to a professionally staffed Contact Center that is open 365 days a year to:
- Report symptoms over the phone or via the web, if preferred
- Access registered nurses for support and feedback
A peak flow meter to measure and track changes

How much does the program cost?

There is no cost to participate in the program, but members may have costs for doctor visits and other care related to COPD. However, these costs are typically much less than the cost of a hospital admission or a visit to the ER.

Remote Patient Monitoring for COPD Provided by HGE Health

horizonbcbsnj — Wed, 20 May 2020 06:08:29 +0000

Remote Patient Monitoring for COPD Provided by HGE Health Wed, 05/20/2020 - 02:08

To help our members better manage their day-to-day respiratory symptoms, Horizon BCBSNJ is working with HGE Health to administer a Chronic Obstructive Pulmonary Disease (COPD) Remote Patient Monitoring program using a clinically validated digital platform and technology-enabled services called HGE Care^TM.

Eligible Members
Horizon BCBSNJ fully insured commercial members diagnosed with COPD are eligible for this program.

Patient outreach is coordinated with the pulmonologists and Primary Care Physicians who direct their care and know them best. A list of eligible patients will be provided to physicians for review and approval prior to patient outreach.

Reimbursement
Services can be billed using CPT Technical (99453 and 99454) and Professional (99457 and 99485) Codes.

There is no cost for the member to participate in the program. Members may have costs for physician visits and other care related to COPD. However, these costs are typically much less than the cost of a hospital admission or visit to the Emergency Room.

How HGE Care Can Help You
HGE Care reduces the time office staff spends on the phone with patients by providing valuable triage services and facilitating physician sign-off on a small number (12 to 15%) of enrolled patients each day directly in the provider’s EHR system.

How does it work?
Patients of all ages and technical proficiency are successfully participating in the HGE Care program. Patients can check in through their own smartphone, tablet or computer, or by calling the HGE Contact Center. Patients enrolled in the program typically log their symptoms daily 80 to 90% of the time.

Through this program, patients have:

Access to a digital health app for logging daily respiratory symptoms and tracking changes
Access to a professionally staffed contact center that is open 365 days a year to report symptoms over the phone or via the web, if preferred
Access to registered nurses for support and feedback
An educational enrollment session to teach them how to assess and report daily symptoms
A peak flow meter to measure and track changes

Multi-Language Support for Your Patients

A Spanish version of the app is available and most other languages are available telephonically with interpreter support through HGE Health.

For more information about HGE Care for your patients, call 1-866-406-7767 or email Providers@hgehealth.com.

Support for your patients’ behavioral health needs. Now and Always.

horizonbcbsnj — Fri, 15 May 2020 16:11:41 +0000

Support for your patients’ behavioral health needs. Now and Always. Fri, 05/15/2020 - 12:11

The COVID-19 pandemic has affected both our physical and mental health, and created new barriers for people already suffering from mental illness and Substance Use Disorders (SUD). Nearly half of all adults in the U.S. report that their mental health has been negatively impacted due to anxiety over the virus.¹ Now more than ever, the need for mental health support and care is clear.

During National Mental Health Awareness Month in May and throughout the year, we are here to help support you and give you the information about the tools and resources available to your patients through their Horizon BCBSNJ health plan.

We are here to help
Our dedicated Horizon Behavioral HealthSM team is available 24/7. If you or your eligible patients have questions about behavioral health benefits, provider access, program support and services, call 1-800-626-2212, 24/7.

The Horizon Behavioral Health team is here to help:

Support continuity of care for your Horizon BCBSNJ patients already engaged in mental health and SUD treatment.
Get other patients access to mental health and SUD treatment as needed.

Access to care
Horizon BCBSNJ contracts with over 6,000 mental health and SUD treatment providers throughout New Jersey. Our behavioral health provider network includes a full spectrum of high-quality, evidence-based treatment – from treatment that is delivered in our members’ home communities, to more intensive residential treatment programs for clients with severe symptoms and presentation.

Programs available for members
In addition to our traditional network of behavioral health services, members’ benefits may also include access to additional support programs and treatment options for mental health and SUD treatment, including:

AbleTo: Horizon Behavioral Health works with AbleTo, Inc. to offer a structured eight-week program that provides emotional support to patients with a chronic illness.
AbleTo Community Support: An in-network virtual therapy option for members seeking support during the COVID-19 crisis. Members can register for this program at ableto.com/register or by calling 1-866-287-1802.
MAP Health Management®: Peer support for individuals who are on the journey to recovery from a SUD. This technology-enabled program is available 24/7 and offered to both members in recovery and their authorized support system (family/friends).
Quartet: The Quartet platform uses technology to help members find the appropriate treatment provider and connects primary care practices with behavioral health providers to improve patient care coordination.
Virtual medication-assisted treatment (MAT): Members with alcohol and opioid use disorders can contact the following in-network provider organizations for help.
- Eleanor Health: 1-856-378-1368, weekdays. 9 a.m. to 5 p.m. and Saturday 9 a.m. to 1 p.m., Eastern Time (ET) eleanorhealth.com/nj-locations
- Workit Health: 1-609-474-0106, weekdays, 9 a.m. to 7 p.m., ET workithealth.com
- Kaden Health: 1-888-885-2336, weekdays, 9 a.m. to 5 a.m., ET (to speak with a live patient advocate) kadenhealth.com info@kadenhealth.com

For more information, call the Horizon Behavioral Health team at 1-800-626-2212. We are here to help you now and in the future.

¹kff.org Report

AbleTo, Inc. and AbleTo, Inc.’s subsidiary, AbleTo Behavioral Health Services PC, are independently contracted by Horizon BCBSNJ to provide remote behavioral health support services. AbleTo, Inc. and AbleTo Behavioral Health Services PC are independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey of the Blue Cross and Blue Shield Association.

MAP Health Management® is a registered mark of MAP Health Management, LLC, an independent company that supports Horizon BCBSNJ in the provision of remote behavioral health support. MAP Health Management is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross and Blue Shield Association.

Quartet supports Horizon Blue Cross Blue Shield of New Jersey in the facilitation of behavioral health benefits. Quartet is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross Blue Shield Association.

Access Member Benefit Information Instantly

horizonbcbsnj — Fri, 15 May 2020 14:19:17 +0000

Access Member Benefit Information Instantly Fri, 05/15/2020 - 10:19

Now, more than ever, you may need to access member benefit information when a hard copy ID card is not available. We want to remind you how you can easily access Horizon BCBSNJ digital member ID cards.

NaviNet®
You can verify your patients’ coverage through NaviNet, even before your patient arrives. Access the Eligibility and Benefits Inquiry section to get all the information you need. You can check membership, verify coverage and see other important information, including an image of the member ID card.

View or print a copy of an ID card from NaviNet

Select Horizon BCBSNJ within the My Health Plans menu.
Mouse over Eligibility & Benefits and select Eligibility & Benefits Inquiry.
Enter your patient’s Horizon BCBSNJ member ID number and then click Search. You may also search by the member’s first name, last name and date of birth if you do not have the member ID number.
Select View next to the member’s name in the member ID card column.

Horizon Blue app
Members can email or text a copy of their member ID card from wherever they are to your practice through the Horizon Blue app.

Secure Member Web Portal
Horizon BCBSNJ members can also send you their ID card by signing in to the secure member web portal HorizonBlue.com. They can download the ID card image and then email it.

You can easily attach/add a digital version of the member ID card to a patient’s electronic health record and it can never be lost, forgotten or damaged.

Thank you for your ongoing support and the care you provide to our members.

Horizon BCBSNJ is #1 in the J.D. Power ranking for Member Satisfaction among Commercial Health Plans in New Jersey

horizonbcbsnj — Thu, 14 May 2020 06:39:22 +0000

Horizon BCBSNJ is #1 in the J.D. Power ranking for Member Satisfaction among Commercial Health Plans in New Jersey Thu, 05/14/2020 - 02:39

Applies to: Commercial markets

At Horizon Blue Cross Blue Shield of New Jersey, we continue to drive for excellence in how we provide best-in-class service for our members and how we work with the doctors, hospitals and health care professionals we rely on to care for them.

That is why we are honored that Horizon BCBSNJ has taken the top spot in the J.D. Power ranking for Member Satisfaction among Commercial Health Plans in New Jersey. This marks the third time in the last four years that Horizon BCBSNJ has earned this important distinction.

Horizon BCBSNJ received the state’s highest ranking in Coverage and Benefits, Costs, Provider Choice and Customer Service.

J.D. Power is a global leader in consumer insights, advisory services and data and analytics.

In addition to the J.D. Power Award, the 2019 Annual Horizon Brand Image Tracking Study conducted among NJ households, named Horizon BCBSNJ as the state’s “#1 Perceived Best Carrier,” earning the top ranking for the following categories:

Coverage members can count on
Access to more doctors/hospitals than others
Meets members’ individual needs
Empowers members to achieve their best health
And, easy to work with

Please contact your Horizon BCBSNJ sales executive or account manager with questions.

COVID-19 Update: 25% Premium Reduction for Fully Insured Commercial Dental Customers

horizonbcbsnj — Tue, 12 May 2020 06:43:32 +0000

COVID-19 Update: 25% Premium Reduction for Fully Insured Commercial Dental Customers Tue, 05/12/2020 - 02:43

Applies to: Fully Insured Commercial Dental Business

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) is reducing premiums by 25% for policies covering 500,000 fully insured Commercial dental members. The reduction is specific to April and May premiums. Eligible subscribers and group customers with in-force coverage will see this reduction in the form of a credit on their July premium invoice. Eligible subscribers and group customers with coverage that terminates will receive a refund. No additional action is required for subscribers and group customers to take advantage of this premium reduction.

Routine dental visits can do more than keep teeth clean. They can also provide early detection of serious health risks, such as diabetes. We want to help ensure our customers can keep this valuable coverage.

“The health and well-being of our members are Horizon’s top priorities, but we are also working to lower their costs to help reduce the financial impact of COVID-19,” said Jared Ferguson, Director, Horizon EXPAND, the Company’s suite of supplemental insurance products.

“This premium reduction applies to the more than 70% of Horizon’s dental policyholders who are in a fully insured plan, including our 60,000 individual policyholders,” added Dr. Joan Monaco, Director, Dental Operations for Horizon BCBSNJ. Another 200,000 dental members are covered through self-insured plans administered by Horizon BCBSNJ on behalf of an employer or other plan sponsor.

Other actions that we have taken due to the COVID-19 pandemic include offering emergency dental premium grace periods and reimbursing dental professionals for care delivered through teledentistry. As it relates to our communities that we work and live in, we have also:

Supported doctors, nurses and hospitals with policies that: protect their health by supporting social distancing and purchasing 500,000 N95 masks; make it easier to deliver and be paid for care provided to members; and eliminate administrative tasks so they can focus all of their resources on delivering critical and life-saving care.
Donated more than $4.5 million to support the safety, medical, social and economic needs of New Jersey’s communities and vital health professionals.

We are grateful for the trust our customers place in us. We have been here when our customers and communities have needed us most. Rest assured, we will continue to provide the coverage and services our customers count on now and always.

Please contact your Horizon BCBSNJ sales executive or account manager with questions.

Coverage decisions

horizonbcbsnj — Tue, 12 May 2020 01:51:43 +0000

Coverage decisions Mon, 05/11/2020 - 21:51

Have you ever wondered how Horizon BCBSNJ makes coverage decisions?

We want you to know that Horizon BCBSNJ:

Makes utilization management (UM) decisions based on the medical necessity and appropriateness of care and service within the guidelines of your benefit coverage.
Does not offer incentives to our employees or delegates performing medical management reviews incentives to encourage denials of coverage or service, and does not provide financial incentives to doctors to withhold covered health care services that are medically necessary and appropriate.
Emphasizes access to the delivery of medically necessary and cost-effective health care services for members.
Encourages the reporting, investigation and elimination of underutilization or overutilization, both of which can result in costly and improper uses of services, and are not helpful to you.
Underutilization is when you aren’t getting enough care or services to properly meet your needs.
Overutilization is when you undergo treatments, tests and studies that you don’t need.

For more information, please call Member Services at 1-800-355-BLUE (2583).

Horizon Blue App Issues

horizonbcbsnj — Mon, 11 May 2020 18:07:48 +0000

Horizon Blue App Issues Mon, 05/11/2020 - 14:07

You may experience technical issues with logging on to the Horizon Blue App. Android users may not be able to utilize fingerprint identification to log in and iOS users may not be able to log in with Face ID/Touch ID. Please log in with your User ID and password. We appreciate your patience as we work to resolve the issue

Horizon BCBSNJ's Member Portal will undergo scheduled maintenance

horizonbcbsnj — Tue, 05 May 2020 15:52:10 +0000

Horizon BCBSNJ's Member Portal will undergo scheduled maintenance Tue, 05/05/2020 - 11:52

Horizon BCBSNJ's Member Portal will undergo scheduled maintenance beginning at 8 p.m. May 29, 2020 until 12 a.m. May 30, 2020. We apologize for the inconvenience and appreciate your patience.

New OMNIA℠ Health Plans for Small Employers and new Horizon Dental Benefit for Mid-size Employers

horizonbcbsnj — Fri, 01 May 2020 06:43:31 +0000

New OMNIA℠ Health Plans for Small Employers and new Horizon Dental Benefit for Mid-size Employers Fri, 05/01/2020 - 02:43

Applies to: Small Employer & Mid-size markets

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) is pleased to announce new Gold and Silver OMNIA℠ Health Plan options for small employers, and new Horizon Dental benefits for mid-size employers, both effective July 1, 2020.

New OMNIA Health Plan Options for Small Employers

The new OMNIA Gold HSA BlueCard plan includes the flexibility of a Health Savings Account (HSA) with out-of-state BlueCard® coverage. Your small business clients will continue to enjoy low costs with leading providers in New Jersey. Members will incur no additional costs once their deductible is met when they use OMNIA Tier 1 doctors, hospitals and other health care professionals.

The new OMNIA Silver Value plan is our most affordable Silver plan. Your clients will continue to enjoy competitive prices, access to the broad Horizon Managed Care Network, and comprehensive benefits with low copays and no deductible when using OMNIA Tier 1 Primary Care Physicians.

Minimum participation and minimum employer contribution requirements do not apply for applications received through November 14, 2020 for OMNIA Gold HSA BlueCard or OMNIA Silver Value plans. This applies regardless of whether the OMNIA Gold HSA BlueCard plan or the OMNIA Silver Value plan is the sole plan offering or one option among multiple plan offerings.

These new options are available now through Horizon BCBSNJ’s Broker Portal and Health Connect for July 1, 2020 and later renewals or new business opportunities. Updated sales enablement materials will soon be available to help you educate your clients on these new offerings.

New Horizon Dental Benefit for Mid-Size Employers
Effective July 1, 2020, new business sales of Horizon Dental Option, Horizon PPO, Horizon Healthy Smiles and Horizon Healthy Smiles Plus plans to pooled groups of 51 to 99 employees will automatically include a 50% to $1,500 lifetime maximum orthodontic benefit for dependents up to age 19 at no additional charge. Horizon Dental Choice and TotalCare plans do not include this new benefit.

Additionally, benefit-waiting periods will no longer apply for new business groups of 51 to 499 employees.

Register Now for a Training Webinar
Horizon BCBSNJ will host training webinars on the new OMNIA Health Plan options and dental plan enhancements.

For information on the training webinars or if you have any questions, please contact your Horizon BCBSNJ sales executive or account manager.

Quarterly Update to Injectable Medication Fee Schedule: Q3 2020

horizonbcbsnj — Thu, 30 Apr 2020 06:04:33 +0000

Quarterly Update to Injectable Medication Fee Schedule: Q3 2020 Thu, 04/30/2020 - 02:04

Horizon BCBSNJ will update our fee schedule for injectable medications on August 1, 2020. Effective August 1, 2020, the fees for the injectable medications listed in the table below will decrease.

We update our injectable medication fee schedule each quarter. The majority of changes made each quarter reflect industry-wide changes to the Average Sales Price (ASP) or the Average Wholesale Price (AWP) of an injectable medication. The changes noted in the table below identify decreases in injectable medication fees that do not reflect industry-wide changes in the ASP or AWP.

Code	Dose	Final Rate	Prior Rate
90281	2 ml	$44.42	$88.64
90746	1 ml	$47.84	$65.12
J0130¹	10 mg	$1,375.15	$1,550.41
J0178	1 mg	$960.32	$966.54
J0222	0.1 mg	$93.23	$95.58
J1447	1 mcg	$0.71	$0.73
J1569	500 mg	$43.13	$43.31
J1626	100 mcg	$0.44	$0.53
J1627	0.1 mg	$1.57	$1.61
J2405	1 mg	$0.29	$0.47
J2469	25 mcg	$3.23	$5.92
J2504¹	25 iu	$354.08	$399.20
J2778	0.1 mg	$353.88	$357.62
J9039	1 mcg	$107.93	$108.00
J9119	1 mg	$26.36	$26.37
J9229	0.1 mg	$2,161.90	$2,162.08
J9285	10 mg	$49.83	$49.93
J9308	5 mg	$59.66	$59.79
Q4159¹	per sq cm	$620.16	$699.20
Q5101	1 mcg	$0.64	$0.72
Q5105	100 units	$1.01	$1.03
Q5106	1,000 units	$10.11	$10.29

¹Change resulting from move to AWP pricing from ASP pricing.

Claims processed on and after August 1, 2020 that include these injectable medications will be reimbursed based on our revised fee schedule information. Horizon BCBSNJ reserves the right to adjust claims for services provided on and after August 1, 2020 that are not reimbursed according to this updated information.

ASP information for Medicare Part B drugs is posted by the Centers for Medicare & Medicaid Services on the first day of the quarter. AWP information, based on data obtained from manufacturers, distributors and other suppliers, is available from a variety of commercial sources.

Fee Schedule Inquiry Tool

The complete injectable medication fee schedule information is available on our Fee Schedule Inquiry tool. Changes to our injectable medication fee schedule information are accessible on and after the effective date of a quarterly update.

To access, log into NaviNet.net, select Horizon BCBSNJ from the My Health Plans menu and:

Mouse over Claim Management
Select Fee Request Inquiry

To view allowances for specific injectable medications or other services:

Select your Billing Provider number, County and Specialty
Enter the desired CPT® and/or HCPCS codes
Select Submit

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

Dates for Prior Authorization Waivers Extended

horizonbcbsnj — Tue, 28 Apr 2020 16:45:31 +0000

Dates for Prior Authorization Waivers Extended Tue, 04/28/2020 - 12:45

Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions

Horizon BCBSNJ has waived precertification/prior authorization requirements for inpatient admissions on or prior to May 31, 2020. These changes are for all Horizon BCBSNJ members, including those covered through Medicaid, Medicare, fully insured and self-insured policies. These changes apply to all inpatient admissions at acute care facilities

Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility Admissions

Effective immediately and through May 31, 2020, Horizon BCBSNJ has extended the waiver for post-acute facility inpatient authorization requirements for admissions to Skilled Nursing, Subacute Physical Rehabilitation and Inpatient Acute Physical Rehabilitation facilities for admissions prior to or on May 31, 2020. This change does not apply to Long Term Acute Care Hospitals (LTACHs).

The following will take effect for admissions to post-acute facilities prior to or on May 31, 2020:

The Notice of Admission can be submitted by the post-acute facility, hospital or health care professional via our online Utilization Management Request Tool accessed on NaviNet®, phone or fax as noted below.
Please include a diagnosis when submitting a request, especially if it is a COVID-19 diagnosis.
Clinical review for the admission will be waived.
Out-of-network receiving facilities should notify Horizon BCBSNJ of the admission. Out-of-network facilities will be paid per the terms of the applicable benefit plan or the agreed-upon rate.
Update: When you have a patient in a post-acute facility for longer than 14 days, concurrent review will be applied.

Contact Information for all Post-Acute Facility Requests:

Horizon NJ Health Members

Phone: 1-800-682-9094, Ext. 89104
Fax: 1-973-274-3867

Medicare Advantage & FIDE-SNP Members

Phone: 1-844-884-2423 (naviHealth)
Fax: 1-866-683-5009

Horizon BCBSNJ Commercial Members

Submit PAFs via our online Utilization Management Request Tool accessed on NaviNet.
Phone: 1-844-243-3450

These changes are effective until May 31, 2020, subject to extension by Horizon BCBSNJ as the COVID-19 pandemic evolves.

Use Modifier CS to Identify Services Subject to Cost Share Waiver

horizonbcbsnj — Mon, 27 Apr 2020 17:38:44 +0000

Use Modifier CS to Identify Services Subject to Cost Share Waiver Mon, 04/27/2020 - 13:38

Effective immediately, practices, providers and facilities should append Modifier CS to procedure codes to indicate that a member’s cost share (i.e., copay, deductible or coinsurance) was not collected for services performed during the COVID-19 pandemic.

Use Modifier CS when no cost share was collected for in-person, telemedicine and phone services occurring during the COVID-19 public health emergency.

This applies to Horizon BCBSNJ and Horizon NJ Health plans.