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Horizon Behavioral Health℠

    Below is important information and links to resources to help behavioral health professionals manage their day-to-day relationship with us.

    To register for one of our educational webinars, access our Training Schedule.

    To stay up to date on provider news and announcements, access News and Legal Notices.

    Access Member Eligibility and Benefits Cost Share Information on NaviNet

    Our Eligibility and Benefits Cost Share Estimator gives you access to medical and behavioral health claim-level member eligibility, benefits and out-of-pocket costs.

    Quickly and Conveniently Update Your Provider Information

    Our Provider Data Maintenance Self Service Portal allows you to update your provider information on NaviNet. This includes changes to your practice locations, affiliated providers, areas of expertise and telemedicine services offered.

    New! Demographic changes can now also be submitted via our Data Submission Template.

    **Learn more about the demographic updates process by registering for one of our training webinars.

    USEFUL LINKS

    For information on the Horizon Behavioral Program for Horizon NJ Health.

    Behavioral Health Provider Resources

  • The Horizon Behavioral Health program ensures behavioral health services, including mental health/substance use disorder treatment, are available to help members better manage all parts of their health. We are focused on making sure our members get the right care when they need it.



    Dedicated support 24/7
    Horizon Behavioral Health is available 24 hours a day, seven days a week. If you or your eligible patients have questions about behavioral health member benefits and program support and services, call 1-800-626-2212.



    Horizon Behavioral Health includes case management and utilization management programs. Our autism care management program provides a dedicated team and resources that reinforce the comprehensive care approach and puts the entire family at the center of care to help ensure each family member receives the support he or she needs.

    • Administrative Policies

    • Applied Behavior Analysis Provider Report Guidelines

    • Blue Review – Provider newsletter

  • Horizon BCBSNJ uses MCG Health's Care Guidelines (MCG) to make behavioral health care coverage determinations for members enrolled in all Horizon BCBSNJ plans.



    American Society of Addiction Medicine (ASAM) criteria is used when making coveragedeterminations for services related Substance Use Disorders.



    Horizon BCBSNJ does notrequire you to have a license to access the MCG Care Guidelines. When the MCG Care Guidelines are used to support an adverse medical necessity determination, the clinical rationale for the determination(s) will be included in the adverse determination letter from Horizon BCBSNJ. Upon request, we will provide the MCG Care Guidelines used in making the specific determination.

    • Demographic updates Electronic Funds Transfer (EFT) Frequently used forms
    NaviNet sign on

  • To register for NaviNet, visit NaviNet.net and click Sign Up under Getting Started with NaviNet.



    All participating physicians and health care professionals are required to register for NaviNet within 30 days of your effective date of participation.



    Through NaviNet, a multi-payer web portal, your office has access to the important Horizon BCBSNJ information (eligibility, benefits, claims status, online Explanations of Payments, submit and check status of UM authorization requests, etc.) that you need to conduct business with us on a day-to-day basis.



    By using NaviNet, your office will have access to Horizon BCBSNJ information, as well as the information of many other New Jersey health plans.



    To learn more about NaviNet, visit NaviNet.net and select Horizon BCBSNJ from the My Health Plans menu.



    • Mouse over References and Resources and select Provider Reference Materials.

    • Mouse over Resources and select Training, then Education.

    • Select NaviNet Information Demo.

    • News and Legal Notices Network Relations Contact Information Office Administrative Manuals Prior Authorization Procedure Search Tool

  • Horizon BCBSNJ manages the recredentialing of behavioral health practitioners and facilities for providers who are due to be recredentialed.



    Please visit our Administrative Policies webpage to review policies related to recredentialing.

  • To contact the Horizon Behavioral Health team regarding service related issues (claims, appeals, benefit information, etc.) call:
    1-800-626-2212
    1-800-991-5579 (for the State Health Benefits Program (SHBP) and the School Employees' Health Benefits Program (SEHBP) Program only)