Home Feed https://www.horizonblue.com/ en New UNITE HERE HEALTH Groups Effective June 1 https://www.horizonblue.com/providers/news/news-legal-notices/new-unite-here-health-groups-effective-june-1 <span class="field field--name-title field--type-string field--label-hidden">New UNITE HERE HEALTH Groups Effective June 1</span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 06/04/2020 - 12:00</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>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.</p> <p>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.</p> <table border="1" cellpadding="1" cellspacing="1" style="width: 500px;"> <tbody> <tr> <td><strong>Group Name</strong></td> <td><strong>Group #</strong></td> <td><strong>Horizon BCBSNJ plan</strong></td> <td><strong>ID Card Prefix</strong></td> </tr> <tr> <td>Food Service Plan 176</td> <td>76305</td> <td>Horizon Direct Access</td> <td>F5Z</td> </tr> <tr> <td>Food Service Plan 176</td> <td>76306</td> <td>Horizon PPO</td> <td>H7B</td> </tr> <tr> <td>Food Service Plan 376</td> <td>76275</td> <td>Horizon Direct Access</td> <td>F4S</td> </tr> <tr> <td>Food Service Plan 376</td> <td>76307</td> <td>Horizon PPO</td> <td>H7P</td> </tr> </tbody> </table> <p>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 (<i>but are not required to</i>) 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.</p> <p>For information about UNITE HERE HEALTH member benefits, please access the Benefits &amp; Eligibility tool within NaviNet or call Physician Services at <strong>1-800-624-1110</strong> or our Centralized Service Center at <strong>1-888-666-2535</strong>.</p> <hr /> <p><strong>PRIOR AUTHORIZATION LISTS</strong><br /> The prior authorization requirements for these new UHH groups (<strong>76305</strong>, <strong>76306</strong>, <strong>76275</strong> and <strong>76307</strong>) vary from our other enrolled UHH groups.</p> <p>To access the <a href="https://www.horizonblue.com/providers/policies-procedures/utilization-management/services-requiring-prior-authorization/unite-here-health/prior-authorization-requirements-uhh-group-s76275-76307-food-service-plan-376-and-uhh-group-s-76305">list of services/procedures that require prior authorization for these new UHH members</a>, please visit <a href="https://www.horizonblue.com/providers/policies-procedures/utilization-management/services-requiring-prior-authorization">Services Requiring Prior Authorization</a>, select click <a href="https://www.horizonblue.com/providers/policies-procedures/utilization-management/services-requiring-prior-authorization/unite-here-health">UNITE HERE HEALTH</a> and select the appropriate UHH group.</p> <p>We encourage all providers to review this information to ensure that prior authorization is obtained where necessary to avoid delays in claim processing.</p> <p><a href="https://www.horizonblue.com/providers/policies-procedures/utilization-management/services-requiring-prior-authorization/unite-here-health/prior-authorization-requirements-uhh-group-76141-atlantic-city-and-uhh-group-76215-new-york">The prior authorization list for members in UHH groups 76215 and 76141 was also updated as follows</a>:</p> <ul> <li>Medical Cost Management Corporation (<strong>1-800-367-9938</strong>) performs PA for habilitative therapy for children with autism spectrum disorder (ABA therapy).</li> </ul> <hr /> <p><strong>SUBMITTING PRIOR AUTHORIZATION REQUESTS</strong><br /> Most prior authorization requests can be submitted online. Simply log into <strong>NaviNet.net</strong>, access our Plan Central page and select <i>Referrals</i> and <i>Authorization</i>, then <i>Utilization Management Requests</i>.</p> <p><a href="https://www.horizonblue.com/providers/policies-procedures/utilization-management/services-requiring-prior-authorization/unite-here-health/prior-authorization-requirements-uhh-group-s76275-76307-food-service-plan-376-and-uhh-group-s-76305">As noted on the online PA list,</a> certain services to be provided to FSP 376 &amp; FSP 176 members require prior authorization through business partners working on our behalf, including:<br /> <br /> &nbsp;&nbsp;&nbsp;&nbsp;eviCore healthcare performs PA for the following services as part of our existing programs</p> <ul> <li><a href="https://www.horizonblue.com/providers/products-programs/evicore-health-care/cardiology-imaging-program">Cardiology Imaging Program</a></li> <li><a href="https://www.horizonblue.com/providers/products-programs/evicore-health-care/molecular-and-genomic-testing-program">Molecular and Genomic Testing Program</a></li> <li><a href="https://www.horizonblue.com/providers/products-programs/evicore-health-care/radiation-therapy-program">Radiation Therapy Program</a></li> <li><a href="https://www.horizonblue.com/providers/products-programs/evicore-health-care/radiology-imaging-services">Radiology/Imaging Program</a></li> </ul> <p>&nbsp;&nbsp;&nbsp;&nbsp;CareCentrix performs PA for the following services as part of our <a href="https://www.horizonblue.com/providers/products-programs/horizon-care-home">Horizon Care@Home program</a>.</p> <ul> <li>Durable Medical Equipment (DME), Home Health Care Services, Home Hospice Services, Home Infusion Services, Prosthetics/Orthotics, Medical Foods</li> </ul> <p>&nbsp; &nbsp; &nbsp;Medical Cost Management Corporation performs PA for habilitative therapy for children with autism spectrum<br /> &nbsp; &nbsp; &nbsp;disorder (ABA therapy).</p> <p>&nbsp; &nbsp; &nbsp;Magellan Rx Management performs PA for Specialty Pharmaceuticals/Medical Injectable Drugs through<br /> &nbsp; &nbsp; &nbsp;our <a href="https://www.horizonblue.com/providers/products-programs/medical-injectables-program">Medical Injectables Program</a></p> </div> Thu, 04 Jun 2020 16:00:27 +0000 horizonbcbsnj 4865 at https://www.horizonblue.com Committed to advance the causes of equality and justice https://www.horizonblue.com/node/4864 <span class="field field--name-title field--type-string field--label-hidden">Committed to advance the causes of equality and justice</span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 06/04/2020 - 11:56</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><a href=" https://www.horizonhealthnews.com/committed-to-advance-the-causes-of-equality-and-justice/ ">Please read this important message from President and CEO Gary D. St. Hilaire</a>.</div> Thu, 04 Jun 2020 15:56:56 +0000 horizonbcbsnj 4864 at https://www.horizonblue.com VRI Program ending June 30, 2020 https://www.horizonblue.com/providers/news/news-legal-notices/vri-program-ending-june-30-2020 <span class="field field--name-title field--type-string field--label-hidden">VRI Program ending June 30, 2020</span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 05/29/2020 - 10:08</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p> 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 <strong>June 30, 2020</strong>. </p> <p> 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 <strong>June 30, 2020</strong>. </p> <p> If you have any questions about this program, please call us: <ul> <li>Horizon BCBSNJ Medicare Advantage providers: <strong>1-800-624-1110</strong></li> <li>Horizon NJ Health and Horizon NJ TotalCare (HMO D-SNP) providers: <strong>1-800-682-9091</strong></li> </ul> </p> <p> Thank you for your continued commitment to your patients, especially during these difficult times. </p></div> Fri, 29 May 2020 14:08:55 +0000 horizonbcbsnj 4861 at https://www.horizonblue.com More products are now eligible for reimbursement through your Health Savings Account (HSA) and Flexible Spending Account (FSA) https://www.horizonblue.com/members/news/member-news/more-products-are-now-eligible-reimbursement-through-your-health-savings-account-hsa-and-flexible <span class="field field--name-title field--type-string field--label-hidden">More products are now eligible for reimbursement through your Health Savings Account (HSA) and Flexible Spending Account (FSA)</span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 05/28/2020 - 21:42</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>On <span class="class-bold">March 27, 2020</span>, the CARES Act was signed into law expanding <a href="https://learn-horizonmyway.hellofurther.com/Individuals/Spending_Your_Account/Eligible_Expenses">the list</a> 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.</p> <p>Eligible items now include:</p> <ul> <li>Over-the-counter (OTC) medicines, which previously were only eligible for reimbursement with a prescription</li> <li>Feminine hygiene products such as tampons, pads, liners, cups and sponges</li> </ul> <p>This change is retroactive to <span class="class-bold">January 1, 2020</span>. This means you can file for reimbursement for these items if you’ve purchased them since January 1.</p> <p><span class="class-bold">How to take advantage of the changes</span></p> <p>It’s easy—just continue to use your debit card as you would for any eligible item.</p> <p>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 <a href="http://www.HorizonBlue.com"><span class="class-bold">HorizonBlue.com</span></a>, the <span class="class-bold">Horizon Blue app</span>, or by faxing or mailing.</p> <p><a name="_GoBack"></a> Sign in at <span class="class-bold"><a href="http://www.HorizonBlue.com">HorizonBlue.com</a></span>and then under the <span class="class-italic">My Accounts </span>section, select <span class="class-italic">Horizon MyWay</span>. Click on <span class="class-italic">View More Activity</span>. Under the <span class="class-italic">I Want To </span>section, select <span class="class-italic">Get Reimbursed</span>.</p> <p><span class="class-bold">Horizon Blue app</span></p> <p>To access your Horizon <span class="class-italic">MyWay</span> account(s) through the <span class="class-bold">Horizon Blue app</span>, simply:</p> <ul> <li>Download and sign in to the <span class="class-bold">Horizon Blue </span>app.</li> <li>Scroll down and tap <span class="class-italic">My Accounts – Out of pocket &amp; spending accounts</span>.</li> <li>Tap <span class="class-italic">Horizon&nbsp;</span><span class="class-italic">MyWay</span></li> </ul> <p><span class="class-bold">How to submit claims</span></p> <ul> <li><span class="class-bold">Fax</span> to <span class="class-bold">1-866-231-0214</span></li> <li><span class="class-bold">Mail </span>to:</li> </ul> <p style="margin-left:40px;"><span class="class-bold">Horizon BCBSNJ FSA</span><br /> <span class="class-bold">PO Box 64193</span><br /> <span class="class-bold">St. Paul, MN 55164-019</span></p> </div> Fri, 29 May 2020 01:42:39 +0000 horizonbcbsnj 4860 at https://www.horizonblue.com Prior Authorization Requirements for UHH Group #s 76275 & 76307 (Food Service Plan 376), and UHH Group #s 76305 & 76306 (Food Service Plan 176) https://www.horizonblue.com/providers/policies-procedures/utilization-management/services-requiring-prior-authorization/unite-here-health/prior-authorization-requirements-uhh-group-s76275-76307-food-service-plan-376-and-uhh-group-s-76305 <span class="field field--name-title field--type-string field--label-hidden">Prior Authorization Requirements for UHH Group #s 76275 & 76307 (Food Service Plan 376), and UHH Group #s 76305 & 76306 (Food Service Plan 176)</span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 05/28/2020 - 13:51</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>The procedures/services outlined here require prior authorization.<br /> <span class="class-bold">This list was revised on June&nbsp;1, 2020 and may be subject to change</span>.</p> <ul> <li>All Inpatient Admissions <ul> <li>surgical admissions</li> <li>medical admissions</li> <li>hospice admissions (exclusive of maternity delivery)</li> <li>rehabilitation facility admissions (acute rehab, skilled nursing and sub-acute</li> <li>mental health and substance abuse admissions</li> </ul> </li> <li>Air Ambulance transportation - NON EMERGENT</li> <li>Bariatric or Gastric Bypass Procedures -Surgery for Morbid Obesity, including but not limited to Bariatric Procedures, Gastroplasty, Gastric Bypass -&nbsp;outpatient</li> <li>Cardiac Radiology Services - Non Emergent Only<br /> Please note that only the following Cardiology Imaging Services require prior authorization by eviCore healthcare for these members <ul> <li>Stress testing (Myocardial perfusion imaging [SPECT and PET], Stress echocardiography)</li> <li>Cardiac CT and MRI</li> <li>Echocardiography: transthoracic and transesophageal</li> <li>Diagnostic heart catheterization</li> </ul> <a href="https://www.horizonblue.com/providers/products-programs/evicore-health-care/cardiology-imaging-program">Visit the Cardiology Imaging Program</a> webpage or call eviCore healthcare at <strong>1-866-496-6200.</strong></li> <li>Clinical Trials</li> <li>Cosmetic procedures and potentially cosmetic procedures including but not limited to cosmetic dermatology services; varicose vein procedures</li> <li>Durable Medical Equipment (DME) - Certain DME items costing over $500<br /> <a href="https://www.horizonblue.com/providers/products-programs/horizon-care-home">Visit the Horizon Care@Home webpage</a> or call CareCentrix at <strong>1-855-243-3321</strong>.</li> <li>Gender Reassignment</li> <li>Habilitative therapy for children with autism spectrum disorder (ABA therapy).<br /> Please call Medical Cost Management Corporation at <strong>1-800-367-9938</strong>.</li> <li>Home Health Care Services – all skilled services in the home</li> <li>Home Hospice Services</li> <li>Home Infusion Services<br /> <a href="https://www.horizonblue.com/providers/products-programs/horizon-care-home">Visit the Horizon Care@Home webpage</a> or call CareCentrix at <strong>1-855-243-3321</strong>.</li> <li>Hyberbaric oxygen therapy</li> <li>Medical Foods</li> <li>Mental health and Substance Abuse Services <ul> <li>Inpatient (IP)</li> <li>Inpatient Detox</li> <li>Residential (RTC)</li> <li>23hr bed</li> <li>72hr bed</li> <li>Partial Hospitalization (PHP)</li> <li>Intensive Outpatient (IOP)</li> <li>Psychological Testing</li> <li>In Home Services</li> <li>Electroconvulsive Therapy (ECT)</li> <li>Transcranial Magnetic Stimulation (TMS)</li> </ul> </li> <li>Molecular and Genomic Testing services<br /> <a href="https://www.horizonblue.com/providers/products-programs/evicore-health-care/molecular-and-genomic-testing-program">Visit the Molecular and Genomic Testing Program webpage</a> or call eviCore healthcare at <strong>1-866-496-6200</strong>.</li> <li>Prosthetics/Orthotics - over $500<br /> <a href="https://www.horizonblue.com/providers/products-programs/horizon-care-home">Visit the Horizon Care@Home webpage</a> or call CareCentrix at <strong>1-855-243-3321</strong>.</li> <li>Radiation Therapy services<br /> <a href="https://www.horizonblue.com/providers/products-programs/evicore-health-care/radiation-therapy-program">Visit the Radiation Therapy Program webpage</a> or call eviCore healthcare at <strong>1-844-224-0493</strong>.</li> <li>Radiology/Imaging Services including but not necessarily limited to: <ul> <li>Magnetic Resonance Imaging (MRI)</li> <li>Magnetic Resonance Angiograms (MRAs)</li> <li>Positron Emission Tomography (PET) scans</li> <li>Positron Emission Tomography – Computed Tomography (PET-CT)</li> <li>Computerized Tomography (CT) scans</li> <li>Computed Tomography Angiography (CTA) scans</li> <li>Nuclear Medicine</li> <li>Nuclear Cardiac Imaging</li> </ul> <a href="https://www.horizonblue.com/providers/products-programs/evicore-health-care/radiology-imaging-services">Visit the Radiology/Imaging Services webpage</a> or call eviCore healthcare at <strong>1-866-496-6200</strong>.</li> <li>Specialty Pharmaceuticals/Medical Injectable Drugs (e.g. Botox, IVIG, Flolan and derivates; Xolair)<br /> <a href="https://www.horizonblue.com/providers/products-programs/medical-injectables-program">Visit the Medical Injectables Program webpage</a> or call Magellan Rx Management at <strong>1-800-424-4508</strong>.</li> <li>Transplant Services except Corneal Transplants (Case Management)</li> <li>Travel and Lodging benefits Call UNITE HERE HEALTH at <strong>1-833-637-3519</strong>.</li> </ul> </div> Thu, 28 May 2020 17:51:32 +0000 horizonbcbsnj 4859 at https://www.horizonblue.com Prior Authorization Requirements for UHH Group #76141(Atlantic City) and UHH Group #76215 (New York) https://www.horizonblue.com/providers/policies-procedures/utilization-management/services-requiring-prior-authorization/unite-here-health/prior-authorization-requirements-uhh-group-76141-atlantic-city-and-uhh-group-76215-new-york <span class="field field--name-title field--type-string field--label-hidden">Prior Authorization Requirements for UHH Group #76141(Atlantic City) and UHH Group #76215 (New York)</span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 05/28/2020 - 13:05</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>The procedures/services outlined here require prior authorization.<br /> <span class="class-bold">This list was revised on June 1, 2020 and may be subject to change.</span></p> <p>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 <a href="/providers/products-programs/evicore-health-care">online</a>.</p> <p>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 <a href="/providers/products-programs/medical-injectables-program">online</a> or call <a href="tel: 1-800-424-4508">1-800-424-4508</a>, Monday through Friday, between 8 a.m. and 5 p.m., ET.</p> <ul> <li>All Inpatient Admissions<br /> All elective acute care, exclusive of maternities (routine maternity admissions are excluded from prior authorization), including: <ul> <li>Elective surgical admissions</li> <li>Elective medical admissions</li> <li>Elective C-section admissions under 38 weeks gestation.</li> <li>Hospice admissions</li> <li>All rehabilitation facility admissions including acute rehab, skilled nursing facility (SNF) and sub-acute admissions</li> <li>Mental health and substance abuse admissions. Prior authorization performed by Optum; call <a href="tel: 1-866-248-4094">1-866-248-4094</a> <p>**Routine maternity admissions are excluded from prior authorization requirement; NOA required**<br /> **NonElective Admission including ER Admissions require Notification of Admission (NOA)**</p> </li> </ul> </li> <li>ABA Therapy (Call Medical Cost Management Corporation at <span class="class-bold">1-800-367-9938 </span>)</li> <li>Ambulance transportation – non-emergent – ground or air</li> <li>Arthroscopy, regardless of setting</li> <li>Bariatric services including gastric bypass and banding procedures</li> <li>Blepharoplasty</li> <li>Cardiac radiology services (non emergent) (prior authorization performed by eviCore healthcare)<br /> Including Non-emergent diagnostic cardiac catheterization/echo stress test</li> <li>Carpal tunnel release</li> <li>Clinical Trials – all</li> <li>Cochlear implants</li> <li>Durable medical equipment (DME) exceeding $500 (Where the total anticipated cost or rental charge exceeds $500)</li> <li>Echocardiograms (prior authorization performed by eviCore healthcare)</li> <li>Electromyogram (EMG)</li> <li>Excision of excessive skin – e.g. due to weight loss</li> <li>Gender reassignment surgery (Call UNITE HERE HEALTH at <span class="class-bold">1-888-437-3480</span>)</li> <li>Genetic testing</li> <li>Gynecomastia – surgical treatment</li> <li>Habilitative therapy for children with autism spectrum disorder (ABA therapy)<br /> (Call Medical Cost Management Corporation at <span class="class-bold">1-800-367-9938</span>)</li> <li>Hip replacement</li> <li>Home health care services – all skilled visits in the home</li> <li>Home IV infusion therapy/services</li> <li>Hormone therapy related to gender reassignment surgery (Call UNITE HERE HEALTH at <span class="class-bold">1-888-437-3480</span>)</li> <li>Hospice care services</li> <li>Hyperbaric oxygen therapy</li> <li>Knee replacement</li> <li>Laminectomy</li> <li>Lipectomy or removal of excessive fat/tissue</li> <li>Mammoplasty (breast reduction)</li> <li>Medical foods for inborn errors of metabolism</li> <li>Meniscectomy</li> <li>Myelogram</li> <li>Occupational therapy</li> <li>Orthognathic jaw surgery including treatment for temporomandibular joint disorder (TMJ) and other craniofacial disorders</li> <li>Orthotics (including podiatric orthotics) over $500</li> <li>Out-of-network requests for consideration of in-network level of benefit when network deficiency exists (Notify UNITE HERE HEALTH of all such requests)</li> <li>Outpatient surgery performed in a hospital-based site of service</li> <li>Percutaneous discectomy reduction</li> <li>Physical therapy – outpatient services and home health visits</li> <li>202 only: podiatric services (All non-routine services)</li> <li>Prosthetics over $500</li> <li>Radiation Therapy (prior authorization performed by eviCore healthcare)</li> <li>Radiology (prior authorization performed by eviCore healthcare) <ul> <li>Cardiac CT scans</li> <li>CT and CTA scans</li> <li>Echocardiogram</li> <li>MRI</li> <li>MRA</li> <li>Nuclear medicine/nuclear cardiology</li> <li>PET and PET/CT scans</li> </ul> </li> <li>Rhinoplasty/septoplasty</li> <li>Sclerotherapy or surgery for varicose veins</li> <li>Sleep studies</li> <li>Speech therapy</li> <li>Submucous resection</li> <li>Transplant services</li> <li>Travel and lodging benefits (Call UNITE HERE HEALTH at <span class="class-bold">1-888-437-3480</span>)</li> <li>Uvulopalatopharyngoplasty (UPPP)</li> </ul> <p>THERE IS NO PRIVATE DUTY NURSING BENEFIT</p> <p>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.</p> <ul> <li>BlueCard®/Out-of-state authorizations<br /> <strong><a href="tel: 1-888-621-5894">1-888-621-5894</a></strong></li> <li>BlueCard®/Out-of-state members (eligibility and benefits)<br /> <strong><a href="tel: 1-800-676-2583">1-800-676-BLUE(2583)</a></strong></li> <li>eviCore healthcare (prior authorization/medical necessity determinations)<br /> Phone: <strong><a href="tel: 1-866-496-6200">1-866-496-6200</a></strong><br /> Fax: <span class="class-bold">1-800-637-5204</span> (radiology services); <span class="class-bold">1-888-785-2480</span> (cardiology services)</li> <li>Home care and/or Home IV infusion<br /> <span class="class-bold">1-800-492-2580</span> (fax)</li> <li>Notices of admission for out-of-state and non-network facilities<br /> <strong><a href="tel: 1-888-621-5894">1-888-621-5894</a></strong></li> <li>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) <strong><a href="tel: 1-866-248-4094">1-866-248-4094</a></strong></li> <li>Physical Therapy: Prior authorization can be obtained online. Simply log into <span class="class-bold">NaviNet.net</span>, access our <em>Plan Central</em> page and select <em>Physical and Occupational Therapy Authorizations</em>. The first 12 visits are usually authorized after a claim is received.&nbsp;</li> <li>Prior-authorization requests: Most PAs can be requested online. Simply log into <span class="class-bold">NaviNet.net</span>, access our <em>Plan Central</em> page and select <em>Referrals and Authorization</em>, then <em>Utilization Management Requests.</em> You may also call<a href="tel: 1-800-664-2583"> <strong>1-800-664-2583</strong></a>.</li> </ul> </div> Thu, 28 May 2020 17:05:02 +0000 horizonbcbsnj 4858 at https://www.horizonblue.com Helping patients with maternal mental health https://www.horizonblue.com/providers/news/news-legal-notices/helping-patients-maternal-mental-health <span class="field field--name-title field--type-string field--label-hidden">Helping patients with maternal mental health</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 05/27/2020 - 13:34</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>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.</p> <p>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.</p> <p>Up to 20 percent of women develop a mood disorder before and after giving birth.<sup>1</sup> 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.</p> <p>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 <strong>1-800-626-2212</strong>, 24/7.</p> <p><strong>Additional Resources</strong>:</p> <p><a href="https://www.who.int/mental_health/maternal-child/maternal_mental_health/en/">Maternal Mental Health&nbsp;</a><br /> <a href="https://www.mhtf.org/topics/perinatal-mental-health/">Maternal Health Task Force at Harvard University</a><br /> <a href="https://www.mhanational.org/conditions/pregnancy-and-postpartum-disorders">Pregnancy and Postpartum Disorders</a><br /> &nbsp;</p> <p><sup>1 </sup><a href="http://nj.gov/health/fhs/maternalchild/mentalhealth/about-disorders">NJ.gov</a></p> </div> Wed, 27 May 2020 17:34:47 +0000 horizonbcbsnj 4857 at https://www.horizonblue.com Dates for Certain Prior Authorization Waivers Further Extended https://www.horizonblue.com/providers/covid-19-information/dates-certain-prior-authorization-waivers-further-extended <span class="field field--name-title field--type-string field--label-hidden">Dates for Certain Prior Authorization Waivers Further Extended</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 05/27/2020 - 12:13</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2>Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions</h2> <p>Horizon BCBSNJ has waived precertification/prior authorization requirements for inpatient admissions on or prior to <strong>June 14, 2020</strong>. 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</p> <h2>Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility Admissions</h2> <p>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.</p> <p>Effective immediately and through <strong>June&nbsp;14, 2020</strong>, 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 <strong>June 14, 2020</strong>. This change does not apply to Long Term Acute Care Hospitals (LTACHs).</p> <p>The following will take effect for admissions to post-acute facilities prior to or on <strong>June 14, 2020</strong>:</p> <ol> <li>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.</li> <li>Please include a diagnosis when submitting a request, especially if it is a COVID-19 diagnosis.</li> <li>Clinical review for the admission will be waived.</li> <li>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.</li> <li><strong>Update:</strong> When you have a patient in a post-acute facility for longer than 14 days, concurrent review will be applied.</li> </ol> <h3>Contact Information for all Post-Acute Facility Requests:</h3> <h4>Horizon NJ Health Members</h4> <p>Phone: <strong>1-800-682-9094, Ext. 89104</strong><br /> Fax: <strong>1-973-274-3867</strong></p> <h4>Medicare Advantage &amp; FIDE-SNP Members</h4> <p>Phone: <strong>1-844-884-2423</strong> (naviHealth)<br /> Fax: <strong>1-866-683-5009</strong></p> <h4>Horizon BCBSNJ Commercial Members</h4> <p>Submit PAFs via our online Utilization Management Request Tool accessed on <a href="https://navinet.navimedix.com/sign-in?ReturnUrl=/">NaviNet</a>.<br /> Phone: <strong>1-844-243-3450</strong></p> <h4>Waiving Authorizations for Oxygen Following ER Discharge</h4> <p>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 <strong>June 30, 2020</strong>.</p></div> Wed, 27 May 2020 16:13:33 +0000 horizonbcbsnj 4856 at https://www.horizonblue.com Sacituzumab govitecan-hziy (Trodelvy) https://www.horizonblue.com/node/4855 <span class="field field--name-title field--type-string field--label-hidden">Sacituzumab govitecan-hziy (Trodelvy)</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 05/27/2020 - 07:59</span> <div class="field field--name-field-medical-policy-type field--type-entity-reference field--label-above"> <div class="field__label">Medical policy type</div> <div class="field__item"><a href="/taxonomy/term/48" hreflang="en">New</a></div> </div> <div class="field field--name-field-third-party-url field--type-string field--label-above"> <div class="field__label">Third Party URL</div> <div class="field__item">https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/SSHH-BPDQS4</div> </div> Wed, 27 May 2020 11:59:56 +0000 horizonbcbsnj 4855 at https://www.horizonblue.com Mitomycin for Pyelocalyceal Solution (Jelmyto) https://www.horizonblue.com/node/4854 <span class="field field--name-title field--type-string field--label-hidden">Mitomycin for Pyelocalyceal Solution (Jelmyto)</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 05/27/2020 - 07:55</span> <div class="field field--name-field-medical-policy-type field--type-entity-reference field--label-above"> <div class="field__label">Medical policy type</div> <div class="field__item"><a href="/taxonomy/term/48" hreflang="en">New</a></div> </div> <div class="field field--name-field-third-party-url field--type-string field--label-above"> <div class="field__label">Third Party URL</div> <div class="field__item">https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/SSHH-BPEMVH</div> </div> Wed, 27 May 2020 11:55:45 +0000 horizonbcbsnj 4854 at https://www.horizonblue.com How to beat back pain https://www.horizonblue.com/members/education-center/preventive-health/how-beat-back-pain <span class="field field--name-title field--type-string field--label-hidden">How to beat back pain</span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 05/26/2020 - 02:16</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>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.</p> <p><span class="class-bold">Rest first, but then get moving.</span> 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.</p> <p><span class="class-bold">Use over-the-counter (OTC) and prescription medicine — with caution. </span>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.</p> <p><span class="class-bold">Consider complementary or alternative care.</span> 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.</p> <p><span class="class-bold">Get physical therapy.</span> 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.</p> <p>Sources: webmd.com; mayoclinic.org; National Institutes of Neurological Disorders and Stroke.</p> </div> Tue, 26 May 2020 06:16:35 +0000 horizonbcbsnj 4850 at https://www.horizonblue.com Molecular and Genomic Testing Program Update: July 2020 https://www.horizonblue.com/providers/news/news-legal-notices/molecular-and-genomic-testing-program-update-july-2020 <span class="field field--name-title field--type-string field--label-hidden">Molecular and Genomic Testing Program Update: July 2020</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 05/25/2020 - 03:52</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>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.</p> <p>For services to be rendered on and after <span class="class-bold">July 1, 2020</span> 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 <a href="https://www.ama-assn.org/system/files/2020-04/cpt-pla-codes-long.pdf">Proprietary Laboratory Analyses (PLA) codes</a>:</p> <ul> <li>0172U</li> <li><a name="Bookmark"></a> 0173U</li> <li>0175U</li> <li>0179U</li> </ul> <p>Review the complete <a href="/sites/default/files/2020-05/Molecular_Code_List.pdf">list of molecular and genomic diagnostic testing services</a> subject to MND review as part of this program or review more details about our <a href="https://www.horizonblue.com/providers/products-programs/evicore-health-care/molecular-and-genomic-testing-program">Molecular and Genomic Testing Program</a>.</p> <p>If you have questions, please contact your Network Specialist or Ancillary Contracting Specialist.</p> <p><span class="class-italic">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).</span></p> <p><span class="class-italic">CPT</span><span class="class-italic">®</span><span class="class-italic"> is a registered trademark of the American Medical Association.</span></p> </div> Mon, 25 May 2020 07:52:15 +0000 horizonbcbsnj 4845 at https://www.horizonblue.com Remote Patient Monitoring for COPD https://www.horizonblue.com/members/plans-and-services/remote-patient-monitoring-copd <span class="field field--name-title field--type-string field--label-hidden">Remote Patient Monitoring for COPD</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 05/20/2020 - 02:22</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><strong>New program provides free remote patient monitoring</strong></p> <p>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.</p> <p>To help make managing COPD easier for you, Horizon BCBSNJ is working with <a href="https://www.hgehealth.com/">HGE Health</a> 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™.</p> <p><a name="Bookmark"></a><span class="class-bold">How does it work?</span></p> <p>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.</p> <p><span class="class-bold">Am I eligible?</span></p> <p>To find out if you’re eligible, or to join, call <span class="class-bold">1-877-709-0995</span>. Representatives are available seven days a week, including holidays and weekends, from 8 a.m. to 8 p.m., Eastern Time.</p> <p>You may also receive a letter from your doctor if you are eligible for this program.</p> <p>For questions about benefits and coverage, call the Member Services number located on the back of your Horizon BCBSNJ member ID card, or <a href="/">sign in</a> to Chat with a Member Services representative.</p> <p><span class="class-bold">What do members receive?</span></p> <p>Through this program, eligible members have:</p> <ul> <li>Access to a digital health app for logging daily respiratory symptoms and tracking changes</li> <li>An enrollment session to teach members how to assess and report daily symptoms</li> <li>Access to a professionally staffed Contact Center that is open 365 days a year to: <ul style="list-style-type:circle;"> <li>Report symptoms over the phone or via the web, if preferred</li> <li>Access registered nurses for support and feedback</li> </ul> </li> <li>A peak flow meter to measure and track changes</li> </ul> <p><span class="class-bold">How much does the program cost?</span></p> <p>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.</p> </div> Wed, 20 May 2020 06:22:57 +0000 horizonbcbsnj 4847 at https://www.horizonblue.com Remote Patient Monitoring for COPD Provided by HGE Health https://www.horizonblue.com/providers/products-programs/remote-patient-monitoring-copd-provided-hge-health <span class="field field--name-title field--type-string field--label-hidden">Remote Patient Monitoring for COPD Provided by HGE Health</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 05/20/2020 - 02:08</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>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<sup>TM</sup>.</p> <p><span class="class-bold">Eligible Members</span><br /> Horizon BCBSNJ fully insured commercial members diagnosed with COPD are eligible for this program.</p> <p>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.</p> <p><span class="class-bold">Reimbursement</span><br /> Services can be billed using CPT Technical (99453 and 99454) and Professional (99457 and 99485) Codes.</p> <p>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.</p> <p><span class="class-bold">How HGE Care Can Help You</span><br /> 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.</p> <p><span class="class-bold">How does it work?</span><br /> 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.</p> <p>Through this program, patients have:</p> <ul> <li>Access to a digital health app for logging daily respiratory symptoms and tracking changes</li> <li>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</li> <li>Access to registered nurses for support and feedback</li> <li>An educational enrollment session to teach them how to assess and report daily symptoms</li> <li>A peak flow meter to measure and track changes</li> </ul> <p><span class="class-bold">Multi-Language Support for Your Patients</span></p> <p>A Spanish version of the app is available and most other languages are available telephonically with interpreter support through HGE Health.</p> <p>For more information about HGE Care for your patients, call<span class="class-bold"> 1-866-</span><span class="class-bold">406-7767 </span>or email<u><a href="mailto:Providers@hgehealth.com"><span class="class-bold"> Providers@hgehealth.com</span></a></u><span class="class-bold">.</span></p> </div> Wed, 20 May 2020 06:08:29 +0000 horizonbcbsnj 4846 at https://www.horizonblue.com Support for your patients’ behavioral health needs. Now and Always. https://www.horizonblue.com/providers/news/news-legal-notices/support-your-patients-behavioral-health-needs-now-and-always <span class="field field--name-title field--type-string field--label-hidden">Support for your patients’ behavioral health needs. Now and Always.</span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 05/15/2020 - 12:11</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>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.<sup>1</sup> Now more than ever, the need for mental health support and care is clear.</p> <p>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.</p> <p><strong>We are here to help</strong><br /> 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.</p> <p>The Horizon Behavioral Health team is here to help:</p> <ul> <li>Support continuity of care for your Horizon BCBSNJ patients already engaged in mental health and SUD treatment.</li> <li>Get other patients access to mental health and SUD treatment as needed.</li> </ul> <p><strong>Access to care</strong><br /> 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.</p> <p><strong>Programs available for members</strong><br /> 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:</p> <ul> <li><strong>AbleTo:</strong> Horizon Behavioral Health works with AbleTo, Inc. to offer a structured eight-week program that provides emotional support to patients with a chronic illness.</li> <li><strong>AbleTo Community Support:</strong> An in-network virtual therapy option for members seeking support during the COVID-19 crisis. <a href="http://ableto.com/register">Members can register for this program at ableto.com/register</a> or by calling <strong>1-866-287-1802</strong>.</li> <li><strong>MAP Health Management®</strong>: 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).</li> <li><strong>Quartet:</strong> 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.</li> <li><strong>Virtual medication-assisted treatment (MAT):</strong> Members with alcohol and opioid use disorders can contact the following in-network provider organizations for help. <ul> <li><strong>Eleanor Health: 1-856-378-1368</strong>, weekdays. 9 a.m. to 5 p.m. and Saturday 9 a.m. to 1 p.m., Eastern Time (ET) <a href="http://eleanorhealth.com/nj-locations">eleanorhealth.com/nj-locations</a></li> <li><strong>Workit Health: 1-609-474-0106</strong>, weekdays, 9 a.m. to 7 p.m., ET <a href="http://workithealth.com/">workithealth.com</a></li> <li><strong>Kaden Health: 1-888-885-2336</strong>, weekdays, 9 a.m. to 5 a.m., ET (to speak with a live patient advocate) <a href="http://kadenhealth.com/">kadenhealth.com</a> <a href="mailto:info@kadenhealth.com">info@kadenhealth.com</a></li> </ul> </li> </ul> <p>For more information, call the Horizon Behavioral Health team at <strong>1-800-626-2212</strong>. We are here to help you now and in the future.</p> <p><span class="small"><sup>1</sup><a href="https://www.kff.org/">kff.org Report</a></span></p> <span class="small"> <p> 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. </p> <p> MAP Health Management&#174; 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. </p> <p> 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. </p> </span></div> Fri, 15 May 2020 16:11:41 +0000 horizonbcbsnj 4844 at https://www.horizonblue.com Access Member Benefit Information Instantly https://www.horizonblue.com/providers/news/news-legal-notices/access-member-benefit-information-instantly <span class="field field--name-title field--type-string field--label-hidden">Access Member Benefit Information Instantly </span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 05/15/2020 - 10:19</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>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.</p> <p><strong>NaviNet&reg;</strong> <br/> You can verify your patients’ coverage through NaviNet, even before your patient arrives. Access the <i>Eligibility and Benefits Inquiry</i> 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.</p> <p> View or print a copy of an ID card from NaviNet <ul> <li>Select Horizon BCBSNJ within the My Health Plans menu.</li> <li>Mouse over Eligibility & Benefits and select Eligibility & Benefits Inquiry.</li> <li>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.</li> <li>Select View next to the member’s name in the member ID card column.</li> </ul> </p> <p><strong>Horizon Blue app</strong> <br/> Members can email or text a copy of their member ID card from wherever they are to your practice through the Horizon Blue app. </p> <p><strong>Secure Member Web Portal</strong> <br/> Horizon BCBSNJ members can also send you their ID card by signing in to the secure member web portal <a href="https://www.horizonblue.com/">HorizonBlue.com</a>. They can download the ID card image and then email it. </p> <p> 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. </p> <p> Thank you for your ongoing support and the care you provide to our members. </p> </div> Fri, 15 May 2020 14:19:17 +0000 horizonbcbsnj 4843 at https://www.horizonblue.com Horizon BCBSNJ is #1 in the J.D. Power ranking for Member Satisfaction among Commercial Health Plans in New Jersey https://www.horizonblue.com/brokers/news/broker-news/horizon-bcbsnj-1-j-d-power-ranking-member-satisfaction-among-commercial-health-plans-new-jersey <span class="field field--name-title field--type-string field--label-hidden">Horizon BCBSNJ is #1 in the J.D. Power ranking for Member Satisfaction among Commercial Health Plans in New Jersey</span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 05/14/2020 - 02:39</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><span class="class-bold">Applies to:</span> Commercial markets</p> <p>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.<br><br> 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.<br><br> Horizon BCBSNJ received the state’s highest ranking in Coverage and Benefits, Costs, Provider Choice and Customer Service.<br><br> J.D. Power is a global leader in consumer insights, advisory services and data and analytics.<br><br> 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:</p><ul><li>Coverage members can count on</li><li>Access to more doctors/hospitals than others</li><li>Meets members’ individual needs</li><li>Empowers members to achieve their best health</li><li>And, easy to work with</li></ul><p>Please contact your Horizon BCBSNJ sales executive or account manager with questions.</p> </div> Thu, 14 May 2020 06:39:22 +0000 horizonbcbsnj 4851 at https://www.horizonblue.com COVID-19 Update: 25% Premium Reduction for Fully Insured Commercial Dental Customers   https://www.horizonblue.com/brokers/news/broker-news/covid-19-update-25-premium-reduction-fully-insured-commercial-dental-customers <span class="field field--name-title field--type-string field--label-hidden">COVID-19 Update: 25% Premium Reduction for Fully Insured Commercial Dental Customers  </span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 05/12/2020 - 02:43</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><span class="class-bold">Applies to:&nbsp;Fully Insured Commercial Dental Business</span></p> <p>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.<br /> <br /> 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.<br /> <br /> “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.<br /> <br /> “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.<br /> <br /> 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:</p> <ul> <li>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.</li> <li>Donated more than $4.5 million to support the safety, medical, social and economic needs of New Jersey’s communities and vital health professionals.</li> </ul> <p>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.<br /> <br /> Please contact your Horizon BCBSNJ sales executive or account manager with questions.</p> </div> Tue, 12 May 2020 06:43:32 +0000 horizonbcbsnj 4853 at https://www.horizonblue.com Coverage decisions https://www.horizonblue.com/members/education-center/coverage-decisions <span class="field field--name-title field--type-string field--label-hidden">Coverage decisions</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 05/11/2020 - 21:51</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><span class="class-bold">Have you ever wondered how Horizon BCBSNJ makes coverage decisions?</span></p><p>We want you to know that Horizon BCBSNJ:</p><ul><li>Makes utilization management (UM) decisions based on the medical necessity and appropriateness of care and service within the guidelines of your benefit coverage.</li><li>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.</li><li>Emphasizes access to the delivery of medically necessary and cost-effective health care services for members.</li><li>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.</li><li>Underutilization is when you aren’t getting enough care or services to properly meet your needs.</li><li>Overutilization is when you undergo treatments, tests and studies that you don’t need.</li></ul><p>For more information, please call Member Services at <span class="class-bold">1-800-355-BLUE (2583)</span>.</p> </div> Tue, 12 May 2020 01:51:43 +0000 horizonbcbsnj 4842 at https://www.horizonblue.com Horizon Blue App Issues https://www.horizonblue.com/node/4841 <span class="field field--name-title field--type-string field--label-hidden">Horizon Blue App Issues</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 05/11/2020 - 14:07</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>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</p> </div> Mon, 11 May 2020 18:07:48 +0000 horizonbcbsnj 4841 at https://www.horizonblue.com Horizon BCBSNJ's Member Portal will undergo scheduled maintenance https://www.horizonblue.com/members/news/member-alerts/horizon-bcbsnj-s-member-portal-will-undergo-scheduled-maintenance <span class="field field--name-title field--type-string field--label-hidden">Horizon BCBSNJ's Member Portal will undergo scheduled maintenance</span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 05/05/2020 - 11:52</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>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.</p> </div> Tue, 05 May 2020 15:52:10 +0000 horizonbcbsnj 4840 at https://www.horizonblue.com New OMNIA&#8480; Health Plans for Small Employers and new Horizon Dental Benefit for Mid-size Employers https://www.horizonblue.com/brokers/news/broker-news/new-omnia-sm-health-plans-small-employers-and-new-horizon-dental-benefit-mid-size-employers <span class="field field--name-title field--type-string field--label-hidden">New OMNIA&#8480; Health Plans for Small Employers and new Horizon Dental Benefit for Mid-size Employers</span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 05/01/2020 - 02:43</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><span class="class-bold">Applies to:</span>&nbsp;Small Employer &amp; Mid-size markets</p> <p>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&nbsp;<span class="class-bold">July 1, 2020</span>.</p> <p><span class="class-bold">New OMNIA Health Plan Options for Small Employers</span></p> <p>The new&nbsp;<span class="class-bold">OMNIA Gold HSA BlueCard&nbsp;</span>plan includes the flexibility of a Health Savings Account (HSA) with out-of-state BlueCard<span class="superscript">®&nbsp;</span>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.</p> <p>The new&nbsp;<span class="class-bold">OMNIA Silver Value&nbsp;</span>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.</p> <p>Minimum participation and minimum employer contribution requirements do not apply for applications received through&nbsp;<span class="class-bold">November 14, 2020&nbsp;</span>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.</p> <p>These new options are available now through Horizon BCBSNJ’s&nbsp;<u><span class="class-bold"><a href="https://secure.horizonblue.com/broker/web/secure/brokers" target="Broker Portal">Broker Portal</a>&nbsp;</span></u>and&nbsp;<u><span class="class-bold"><a href="https://portal.healthconnectsystems.com/Login.aspx" target="HealthConnect">Health Connect</a>&nbsp;</span></u>for&nbsp;<span class="class-bold">July 1, 2020&nbsp;</span>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.&nbsp;</p> <p><span class="class-bold">New Horizon Dental Benefit for Mid-Size Employers</span><br /> Effective&nbsp;<span class="class-bold">July 1, 2020</span>, 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.</p> <p>Additionally, benefit-waiting periods will no longer apply for new business groups of 51 to 499 employees.</p> <p><span class="class-bold">Register Now for a Training Webinar</span><br /> Horizon BCBSNJ will host training webinars on the new OMNIA Health Plan options and dental plan enhancements.</p> <p>For information on the training webinars or if you have any questions, please contact your Horizon BCBSNJ sales executive or account manager.</p> </div> Fri, 01 May 2020 06:43:31 +0000 horizonbcbsnj 4852 at https://www.horizonblue.com Quarterly Update to Injectable Medication Fee Schedule: Q3 2020 https://www.horizonblue.com/providers/news/news-legal-notices/quarterly-update-injectable-medication-fee-schedule-q3-2020 <span class="field field--name-title field--type-string field--label-hidden">Quarterly Update to Injectable Medication Fee Schedule: Q3 2020</span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 04/30/2020 - 02:04</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Horizon BCBSNJ will update our fee schedule for injectable medications on <span class="class-bold">August 1, 2020</span>. Effective August 1, 2020, the fees for the injectable medications listed in the table below will decrease.</p> <p>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.</p> <table> <tbody> <tr> <td><span class="class-bold">Code</span></td> <td><span class="class-bold">Dose</span></td> <td><span class="class-bold">Final Rate</span></td> <td><span class="class-bold">Prior Rate</span></td> </tr> <tr> <td>90281</td> <td>2 ml</td> <td>$44.42</td> <td>$88.64</td> </tr> <tr> <td>90746</td> <td>1 ml</td> <td>$47.84</td> <td>$65.12</td> </tr> <tr> <td>J0130¹</td> <td>10 mg</td> <td>$1,375.15</td> <td>$1,550.41</td> </tr> <tr> <td>J0178</td> <td>1 mg</td> <td>$960.32</td> <td>$966.54</td> </tr> <tr> <td>J0222</td> <td>0.1 mg</td> <td>$93.23</td> <td>$95.58</td> </tr> <tr> <td>J1447</td> <td>1 mcg</td> <td>$0.71</td> <td>$0.73</td> </tr> <tr> <td>J1569</td> <td>500 mg</td> <td>$43.13</td> <td>$43.31</td> </tr> <tr> <td>J1626</td> <td>100 mcg</td> <td>$0.44</td> <td>$0.53</td> </tr> <tr> <td>J1627</td> <td>0.1 mg</td> <td>$1.57</td> <td>$1.61</td> </tr> <tr> <td>J2405</td> <td>1 mg</td> <td>$0.29</td> <td>$0.47</td> </tr> <tr> <td>J2469</td> <td>25 mcg</td> <td>$3.23</td> <td>$5.92</td> </tr> <tr> <td>J2504¹</td> <td>25 iu</td> <td>$354.08</td> <td>$399.20</td> </tr> <tr> <td>J2778</td> <td>0.1 mg</td> <td>$353.88</td> <td>$357.62</td> </tr> <tr> <td>J9039</td> <td>1 mcg</td> <td>$107.93</td> <td>$108.00</td> </tr> <tr> <td>J9119</td> <td>1 mg</td> <td>$26.36</td> <td>$26.37</td> </tr> <tr> <td>J9229</td> <td>0.1 mg</td> <td>$2,161.90</td> <td>$2,162.08</td> </tr> <tr> <td>J9285</td> <td>10 mg</td> <td>$49.83</td> <td>$49.93</td> </tr> <tr> <td>J9308</td> <td>5 mg</td> <td>$59.66</td> <td>$59.79</td> </tr> <tr> <td>Q4159¹</td> <td>per sq cm</td> <td>$620.16</td> <td>$699.20</td> </tr> <tr> <td>Q5101</td> <td>1 mcg</td> <td>$0.64</td> <td>$0.72</td> </tr> <tr> <td>Q5105</td> <td>100 units</td> <td>$1.01</td> <td>$1.03</td> </tr> <tr> <td>Q5106</td> <td>1,000 units</td> <td>$10.11</td> <td>$10.29</td> </tr> </tbody> </table> <p>¹<span class="class-italic">Change resulting from move to AWP pricing from ASP pricing.</span></p> <p>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.</p> <p><a href="http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/index.html">ASP information for Medicare Part B drugs is posted</a> by the Centers for Medicare &amp; 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.</p> <hr> <p><span class="class-italic"><span class="class-bold">Fee Schedule Inquiry</span></span><span class="class-bold"> Tool </span></p> <p>The complete injectable medication fee schedule information is available on our <span class="class-italic">Fee Schedule Inquiry</span> tool. Changes to our injectable medication fee schedule information are accessible on and after the effective date of a quarterly update.</p> <p>To access, log into <span class="class-bold">NaviNet.net</span>, select <span class="class-italic">Horizon BCBSNJ</span> from the <span class="class-italic">My Health Plans</span> menu and:</p> <ul> <li>Mouse over <span class="class-italic">Claim Management</span></li> <li>Select <span class="class-italic">Fee Request Inquiry</span></li> </ul> <p>To view allowances for specific injectable medications or other services:</p> <ul> <li>Select your <span class="class-italic">Billing Provider</span> number, <span class="class-italic">County</span> and <span class="class-italic">Specialty</span></li> <li>Enter the desired CPT® and/or HCPCS codes</li> <li>Select <span class="class-italic">Submit</span></li> </ul> <p><span class="class-italic">CPT</span>®&nbsp;<span class="class-italic">is a registered mark of the American Medical Association.</span></p> </div> Thu, 30 Apr 2020 06:04:33 +0000 horizonbcbsnj 4832 at https://www.horizonblue.com Dates for Prior Authorization Waivers Extended https://www.horizonblue.com/providers/covid-19-information/dates-prior-authorization-waivers-extended <span class="field field--name-title field--type-string field--label-hidden">Dates for Prior Authorization Waivers Extended</span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 04/28/2020 - 12:45</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2>Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions</h2> <p>Horizon BCBSNJ has waived precertification/prior authorization requirements for inpatient admissions on or prior to <strong>May 31, 2020</strong>. 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</p> <h2>Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility Admissions</h2> <p>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.</p> <p>Effective immediately and through <strong>May 31, 2020</strong>, 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 <strong>May 31, 2020</strong>. This change does not apply to Long Term Acute Care Hospitals (LTACHs).</p> <p>The following will take effect for admissions to post-acute facilities prior to or on <strong>May 31, 2020</strong>:</p> <ol> <li>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.</li> <li>Please include a diagnosis when submitting a request, especially if it is a COVID-19 diagnosis.</li> <li>Clinical review for the admission will be waived.</li> <li>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.</li> <li><strong>Update:</strong> When you have a patient in a post-acute facility for longer than 14 days, concurrent review will be applied.</li> </ol> <h3>Contact Information for all Post-Acute Facility Requests:</h3> <h4>Horizon NJ Health Members</h4> <p>Phone: <strong>1-800-682-9094, Ext. 89104</strong><br /> Fax: <strong>1-973-274-3867</strong></p> <h4>Medicare Advantage &amp; FIDE-SNP Members</h4> <p>Phone: <strong>1-844-884-2423</strong> (naviHealth)<br /> Fax: <strong>1-866-683-5009</strong></p> <h4>Horizon BCBSNJ Commercial Members</h4> <p>Submit PAFs via our online Utilization Management Request Tool accessed on <a href="https://navinet.navimedix.com/sign-in?ReturnUrl=/">NaviNet</a>.<br /> Phone: <strong>1-844-243-3450</strong></p> <p>These changes are effective until <strong>May 31, 2020</strong>, subject to extension by Horizon BCBSNJ as the COVID-19 pandemic evolves.</p> </div> Tue, 28 Apr 2020 16:45:31 +0000 horizonbcbsnj 4836 at https://www.horizonblue.com Use Modifier CS to Identify Services Subject to Cost Share Waiver https://www.horizonblue.com/providers/covid-19-information/use-modifier-cs-identify-services-subject-cost-share-waiver <span class="field field--name-title field--type-string field--label-hidden">Use Modifier CS to Identify Services Subject to Cost Share Waiver</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 04/27/2020 - 13:38</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>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.&nbsp;</p> <p>Use Modifier CS when no cost share was collected for in-person, telemedicine and phone services occurring during the COVID-19 public health emergency.</p> <p>This applies to Horizon BCBSNJ and Horizon NJ Health plans.</p> </div> Mon, 27 Apr 2020 17:38:44 +0000 horizonbcbsnj 4835 at https://www.horizonblue.com