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Horizon BCBSNJ conducts a monthly audit on updated records. The carrier’s website address where the electronic directory can be accessed. This policy also helps ensure that the contents of the directories are fully compliant with all regulatory and accrediting requirements. Find my BCBS company . You are now leaving Horizon Blue Cross Blue Shield's website for DSM employees. 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. Policy: For questions on the … You have until January 31, 2021 to apply for Individual health care coverage effective February 1, 2021. Or, if you would like to remain in the current site, click Cancel. Learn more about Braven Health and your participation status. 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. This website does not display all Qualified Health Plans available through Get Covered NJ. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and … Answers and care made simple The Horizon Blue app offers easy access to your insurance information, including benefits, coverage details and status of your claims. You are now leaving Horizon Blue Cross Blue Shield's website for DSM employees. Back. Commercial HMO & POS, #1 in Member Satisfaction among Commercial Health Plans in NJ, 3 out of 4 Years, 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. 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