Claim forms and claims-related forms.
Transition Care, also referred to as treatment in progress, is a benefit that allows new subscribers and covered dependents to receive medical care by non-participating providers at the in-network benefit level for treatment of an acute injury or illness. Transition care is short term and not intended to replace the regular provisions of the program.
ID: 7164 (W0312)
This form authorizes Horizon BCBS to obtain any and all medical records and information from providers of service and/or hospitals, relating to the subscriber and eligible dependents, to the extent required to administer the Plan.
ID: 3247 (W0312)
New Jersey State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP)members with NJ DIRECT should use this form to file claims.
ID: 2642 (W0714)