The $200 reimbursement and any amounts paid out-of-pocket for health club reimbursement do not count toward your maximum out-of-pocket … Exchange POS/EPO, Applicable Products: You have peace of mind knowing that your coverage includes the BlueCard PPO program. Your PCP is a duly licensed practitioner who has entered into an agreement with us to participate in the Horizon BCBSNJ Managed Care Network and is responsible for coordinating all aspects of your medical care, including referrals to specialists, ancillary providers, or inpatient facilities. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. ProfilePoints ™ measure the overall completeness of a provider's profile, including items like having a photo, a biography, insurance, payment options, etc. Need a form? The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Braven Health℠ name and symbols are service marks of Braven Health. A. A full breakdown of points can be seen by providers with Doctor.com accounts when editing their profile on Doctor.com. As of … Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. This site was designed to assist Horizon Blue Cross Blue Shield of New Jersey employees in communicating our brand properly and consistently to our vendors, providers, customers and prospects. Please click Continue to leave this website in order to access the Plan Comparison Tool where you can compare medical plan costs. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. How to Locate a Horizon Direct Access Provider Members can locate Horizon Direct Access network providers by using this Web site feature. Services and products may be provided through Horizon Blue Cross Blue Shield of New Jersey, Horizon Healthcare of New Jersey, Inc., Horizon Healthcare Dental, Inc., Horizon Casualty Services, Inc., or Horizon NJ Health*, a product of Horizon HMO, each of which is an independent licensee of the Blue Cross and Blue Shield Association. Horizon BCBSNJ Health Insurance Marketplace Classic Formulary Drug Guide January 2020 (Plan Year 2019) I . Members can also call Member Services at 1-800-355-BLUE (2583) to access participating providers. Check Eligibility Please click Continue to leave this website. ET on Monday, February 15. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Register to attend one of our educational webinars. Or you may go to any other physician or specialist if you choose not to coordinate care through your PCP. To see all available Qualified Health Plan options, go to the New Jersey Health Insurance Marketplace at Get Covered NJ. As your personally selected doctor, your PCP provides medical care or refers you to the appropriate source for medical care, whether that source is a specialist physician, ancillary provider, or inpatient facility. RegisterRegister open in a new window. A: Coverage for breast pumps is subject to the terms, conditions and limitations of the member’s contract. Select Blue Cross Blue Shield Global™ or GeoBlue if you have international coverage and need to find care outside the United States. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Consider these top-rated diets, What You Need to Know About Metabolic Syndrome, Calculator for the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act, HCR (Health Care Reform) Preventive Care Information Guide, How to Find an In-Network Provider, Care Facility or Pharmacy, The Role of Your Primary Care Physician or Personal Doctor, Third Party Designation for Senior Citizen Insureds, Urgent care centers: an alternative to the Emergency Room, Getting the Most From Your OMNIA Health Plan, Blue Cross Blue Shield Global Core and GeoBlue, Claims Payment Policies and Other Information. The Benefit of Blue℠ is a service mark of the Blue Cross Blue Shield Association. Use the National Doctor and Hospital Finder to locate participating doctors and hospitals near or at your travel destination in the United States. Horizon Blue Cross Blue Shield of New Jersey Direct Access Point-of-Service (POS) The Direct Access Point-of-Service (POS) plan is administered by Horizon Blue Cross Blue Shield of New Jersey. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Services and products may be provided through Horizon Blue Cross Blue Shield of New Jersey, Horizon Healthcare of New Jersey, Inc., Horizon Healthcare Dental, Inc., Horizon Casualty Services, Inc., or Horizon NJ Health*, a product of Horizon HMO, each of which is an independent licensee of the Blue Cross and Blue Shield Association. Home / Providers / Beacon Health Options / Network-Specific Info / Horizon Blue Cross Blue Shield of New Jersey. Horizon Direct Access is a direct access plan that gives you flexibility in choosing your medical care. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon Blue Cross Blue Shield of New Jersey’s Medication Therapy Management Program (MTM program) is part of our Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. All are independent licensees of the Blue Cross and Blue Shield Association. Your PCP also coordinates the health care services you obtain from providers participating in the Horizon Managed Care Network and provides care or a referral for preventive care services. Exchange POS/EPO, Applicable Products: Commercial HMO & POS, #1 in Member Satisfaction among Commercial Health Plans in NJ, 3 out of 4 Years, For Essential Workers, COVID-19 Treatment Covered Under Workers’ Compensation Benefits, Submitting Pharmacy Claims for COVID-19 Vaccinations, Update: Prior Authorization Requirements for Inpatient Admissions and Post-Acute Facility Admissions to be Reinstated, COVID-19 vaccine administration reimbursement at UCCs, COVID-19 vaccines available in Essex County – Information for your staff and patients, Reimbursement Policy effective January 1, 2021: Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005), Update: Members’ cost sharing waived for treatment of COVID-19 through March 2021, COVID-19 vaccines will be covered at 100%, Waiving Prior Authorization Requirements for Emergent In-Network Inpatient Admissions and Post-Acute Facility Admissions, Update: Cost-share waiver for telemedicine and COVID-19 testing extended, Cost Sharing on Claims with Multiple Diagnoses, Dates for Certain Prior Authorization Waivers Further Extended, Dates for Prior Authorization Waivers Extended, New Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769, COVID-19 Update: Medical Policy Revisions & Implementations, 72 Doctors, Nurses, Pharmacists and Health Clinicians from Horizon BCBSNJ Answer Governor Murphy’s “HealthCare Professionals Call to Serve”, New Jersey Pandemic Relief Fund Efforts Get $2 Million Boost from Horizon, A special message from Howard A. Cutler, Vice President, Healthcare Delivery, Behavioral Health Continuity During the COVID-19 Public Health Emergency, Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility Admissions, Horizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health Professionals, COVID-19 Update: Authorizations Waived for Oxygen Following ER Discharge, Reminder to use specific codes when evaluating for COVID-19, COVID-19 Update: Telemedicine Reimbursement Policy Addenda, Provisionally Join Horizon BCBSNJ Network(s) to Assist with the COVID-19 Pandemic, Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions, Providing Telephonic care with no costs to members, COVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine Services, Eliminating Cost Sharing Related to COVID-19 Testing and Evaluation, Join a Horizon BCBSNJ or Horizon NJ Health Network (Physicians and Other Healthcare Professionals ), Join the Horizon BCBSNJ Network (Ancillary Providers), Join the Horizon NJ Health Network (Ancillary Providers), BlueCard Medical Policy/Pre-Certification Info, Braven Health℠ Electronic Data Interchange (EDI), Horizon BCBSNJ Electronic Data Interchange (EDI), Prior Authorization/Pre-Service Registration, Specialty Pharmaceuticals for Office Administration, Medicare Advantage Network Plans Overview, Braven Health℠ Plans(Medicare Advantage), New Jersey Infection Prevention Partnership, Remote Patient Monitoring for COPD Provided by HGE Health, Referral Process Using the Interactive Voice Response System, Effective use of the Interactive Voice Response System, Surgical and Implantable Device Management Program, About the Surgical and Implantable Device Management Program, Surgical and Implantable Device Management Program for Cardiac Surgeries Frequently Asked Questions Updated: October 6, 2020, Surgical and Implantable Device Management Program Orthopedic Services Frequently Asked Questions Updated: October 6, 2020, Using Out-of-Network Providers in Surgical Services, CMS Audits to Validate Directory Information, Time Limits for Filing Inquiries/Complaints, Appeals of Non-Utilization Management Determinations, Appeals of Utilization Management/Medical Management Determinations, Appeals of Post Service Medical Necessity Determinations, Allowable Practice Locations for Pathologists, Appointment Availability Access Standards for Primary Care-Type Providers, ObGyns, Specialists and Behavioral Health Providers, Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers, Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals, EDI and NaviNet Claims Submission Requirement, Material Adverse Change (MAC) Notification Policy, Outlier Audit Programs: Post Payment and Pre-Payment, Physician and Healthcare Professional Counseling and Termination Policy - Professional Competency, Participation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon Network, Practitioner Office Site Quality and Medical Record Keeping Standards, Standards for All Types of Medical and Dental Diagnostic Radiology and Imaging Facilities, Use of Horizon Hospital Network Performance Data, Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005), Ambulatory Electrocardiographic Monitoring, Bariatric Surgery Billed With Hiatal Hernia Repair, Billing Guidelines for Maternity Services, Cardiovascular Implant Device Monitoring Services, Claims Requiring Additional Documentation, Continuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) Supplies, Daily Management of Epidural or Subarachnoid Continuous Drug Administration, Daily Maximum Units for Surgical Pathology and Microscopic Examination, Distinct Procedural Service Modifiers (59, XE, XP, XS, XU), Duplicate Claim Logic for Independent Laboratory Services, Evaluation and Management Services with Chiropractic Manipulative Treatment, Evaluation and Management Services with Osteopathic Manipulative Treatment, Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion Imaging, Frequency of Care Coordination Services and ESRD Procedures, Hospital Non-Patient Laboratory Services Sample Fees, Laser Treatment of Psoriasis or Parapsoriasis, Mutually and Non-Mutually Exclusive NCCI Supplemental Edits, Outpatient Laboratory Claims: Referring Practitioner Required, Physician Extenders Non-Surgical Services, Pre-Payment Documentation Requests: Facility Claims, Post Payment Documentation Requests: Facility Claims, Pulmonary Diagnostic Procedures when billed with E&M Codes, Reimbursement and Billing Guidelines for Anesthesia Claims, Removal of Impacted Cerumen Requiring Instrumentation, Screening and Diagnostic Mammography & 3D Tomosynthesis, Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and products, Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare Advantage, Urinalysis with Evaluation and Management (E&M) Services, PT/OT Outpatient Prior Authorization for Horizon Medicare Advantage Plans, Prior Authorization Procedure Search Tool, Prior Authorization Requirements for UHH Group #76141(Atlantic City), Prior Authorization Requirements for UHH Group 76215 76315 (New York), Prior Authorization Requirements for UHH Group #s76275 & 76307 (Food Service Plan 376), and UHH Group #s 76305 & 76306 (Food Service Plan 176), Policies, Procedures and General Guidelines, Programs Administered by eviCore healthcare, Participating Physician and Other Health Care Professional Office Manual, Radiation Therapy Medical Necessity Determination, Radiology Professional Group Assessment Tool. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. Please click Continue to leave this website in order to access the Plan Comparison Tool where you can compare medical plan costs. Coverage for breast pumps is subject to the terms, conditions and limitations of the member’s contract. Please refer to your benefit booklet for detailed coverage information regarding your plan’s benefits. For J.D. Your Horizon Direct Access plan starts with your Primary Care Physician (PCP). Anthem Blue Cross Blue Shield’s Medical Associate Volunteer Program allows their employees the opportunity to take paid leave from their regular role and use their medical expertise and training to support providers and deliver care and relief. We apologize for the inconvenience. Last updated on: August 7, 2019, 03:18 AM ET. Is Breastfeeding Right for You and Your Baby? Yes, with the Horizon Blue app, you get 24/7 access to your plan information, care and support from your smartphone or other mobile device. New Jersey's phased approach to administer COVID-19 vaccines to those who live, work or study in the state is now underway. Horizon NJ Health Care / Case Manager To speak with a Horizon NJ Health Care/Case Manager or learn about a Disease Management Program, please call: ‌ 1-800-682-9094 . The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. Although the new Horizon Plan does not require referrals, the Plan still requires you to … This is from a receiving end perspective, not from an insured party perspective. Services and products may be provided through Horizon Blue Cross Blue Shield of New Jersey, Horizon Healthcare of New Jersey, Inc., Horizon Healthcare Dental, Inc., Horizon Casualty Services, Inc., or Horizon NJ Health*, a product of Horizon HMO, each of which is an independent licensee of the Blue Cross and Blue Shield Association. ET on Friday, February 12 until 6 p.m. About 234,000 people have signed … Signing up with Horizon Blue Cross Blue Shield of New Jersey will cost you big in the years to come. Quarterly Update to Injectable Medication Fee Schedule: Q2 2021, UNITE HERE HEALTH Prior Authorization Update: UHH Group #76141 (Atlantic City). Review information about the Horizon Behavioral Health program. Products and services are provided by Horizon Blue Cross Blue Shield of New Jersey, Horizon Insurance Company, Horizon Healthcare of New Jersey, Braven Health, and/or Horizon Healthcare Dental, Inc., each an independent licensee of the Blue Cross and Blue Shield Association. Just click here to access the Physician Finder. Funds for the payment of claims and services come from funds supplied by the State, participating local employers, and members. ProfilePoints ™ measure the overall completeness of a provider's profile, including items like having a photo, a biography, insurance, payment options, etc. Members also have online access to claim status and other services to help make their health care experience more satisfying. In the fight against coronavirus (COVID-19), we’re covering more of your patients’ costs and making their access to doctors and nurses easier. NJ DIRECT HDHP is self-funded. For J.D. Horizon Behavioral Health SM: 2020 Management Change. Images of the Horizon Blue Cross Blue Shield headquarters in Newark. Of course, you'll get outstanding health plan options. Our employees bring … Our forms are located in one convenient location. This is from a receiving end perspective, not from an insured party perspective. Plus, Horizon BCBSNJ offers toll-free customer service Monday through Friday, 8 a.m. to 6 p.m., Eastern Time (ET), so members can get the help they need. In the United States, Puerto Rico and U.S. Virgin Islands. Commercial PPO/EPO & This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Horizon Blue Cross Blue Shield of New Jersey. If you do not have an account, you can request for one. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. (Courtesy of Horizon) 6. 103 reviews of Horizon Blue Cross Blue Shield of New Jersey "Horizon BCBS of NJ Dealing with insurance companies on a daily basis is very daunting. Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019 - 12/31/2019 Horizon BCBSNJ: State Health Benefits Program- NJ DIRECT HD1500 Coverage for: All Coverage Types Plan Type: HDHP (NJ DIRECT (HDHP)) 1 of 11 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Introduction . Horizon Blue Cross Blue Shield NJ Doctor & Hospital Finder - Online provider directory for best doctors, dentists, hospitals and PCPs by your location, specialty near you. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. You are leaving the Horizon Blue Cross Blue Shield of New Jersey website. More than 90 percent of all doctors and hospitals throughout the United States participate in the BlueCard PPO national network. Home / Providers / Beacon Health Options / Network-Specific Info / Horizon Blue Cross Blue Shield of New Jersey Provider Groups and Facilities may visit our provider portal or call our National Provider Service Line at 800-397-1630 to share your individual provider information. You can coordinate your care through your Primary Care Physician (PCP) to obtain the highest level of benefits (the selection of a PCP is optional), visit a physician in the Horizon BCBSNJ Managed Care Network, or go directly to any licensed doctor. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. $0 in-network Annual Medical Deductible ; $5 for in-network primary doctor copay; $0 copay for doctors by phone, video or online chat; Plus you'll have both in-and out-of-network benefits *Only available in Atlantic, Cumberland and Mercer Counties. In order to access our Dental Policies, please read the following information and indicate your agreement with the terms by clicking below. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. Horizon Blue Cross Blue Shield of New Jersey. Power 2020 award information, visit jdpower.com/awards. All are independent licensees of the Blue Cross and Blue Shield Association. It's free! Apply for individual or family medical, dental, and life insurance plans. Horizon Blue Cross Blue Shield of New Jersey P.O. New for 2021 Horizon Medicare Blue Access (PPO) Features Include. All appointment times are guaranteed by our Horizon Blue Cross Blue Shield of New Jersey Acupuncturists & Providers. All are independent licensees of the Blue Cross and Blue Shield … We’re always here for you and your patients. New Jersey's phased approach to administer COVID-19 vaccines to those who live, work or study in the state is now underway. ProfilePoints ™ measure the overall completeness of a provider's profile, including items like having a photo, a biography, insurance, payment options, etc. In the fight against coronavirus (COVID-19), Genetic Testing for Cardiac Ion Channelopathies, Claims Payment Policies and Other Information. Blue Shield of California welcomes you. Access to a network of over 16,000 participating fitness centers. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. Blue Cross & Blue Shield of Rhode Island).. The Benefit of Blue℠ is a service mark of the Blue Cross Blue Shield Association. ... Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Or, click Cancel to remain on the current site. Horizon Direct Access is a managed care plan that gives you access to many health care services and programs and our large national participating physician network.