At Your Service
IVR and PHONE INQUIRIES
Provider Services: 1-800-624-1110
Institutional Services: 1-888-666-2535
Find forms at HorizonBlue.com/providers/forms.
CLAIM SUBMISSION
All claims should be submitted electronically.
Use Payer ID 22099 if you use a vendor or clearinghouse. Primary claims, including claims using a legacy provider ID (TIN + suffix), behavioral health claims and claims requiring a medical record, can be submitted from the Horizon BCBSNJ page after logging in to NaviNet.net.
PROFESSIONAL CLAIMS
HCAPPA Appeals: Use Appeal a Claims Determination form and mail to PO Box 10129, Newark, NJ 07101-3129
General Appeals: Use 579 form and mail to PO Box 54, Newark, NJ 07101-0054
Inquiries: Use 579 form and mail to PO Box 199, Newark, NJ 07101-0199
FACILITY CLAIMS
Appeals/inquiries: Use 579 form and mail to PO Box 1770, Newark, NJ 07101-1770
FEP®
Claim Inquiries:
PO Box 656, Newark, NJ 07101-0656
Reconsiderations/Appeals: 1-800-624-5078
PO Box 10181, Newark, NJ 07101
Precertification: 1-800-664-2583
Case Management and Health and Wellness: 1-866-697-9696
BLUECARD® Claim Appeals/Inquiries:
PO Box 1301, Neptune, NJ 07754-1301 1-888-435-4383
SHBP/SEHBP
Claim Appeals/Inquiries:
PO Box 820, Newark, NJ 07101-0820
Physician Services: 1-800-624-1110
Institutional Services: 1-888-666-2535
Utilization Management: 1-800-664-2583
Advanced Radiology –
eviCore healthcare: 1-866-496-6200
Behavioral Health Precertification: 1-800-991-5579
ELIGIBILITY AND BENEFITS
Log in to NaviNet.net and access the Horizon BCBSNJ page. Mouse over Eligibility & Benefits and select Eligibility & Benefits Inquiry.
PRIOR AUTHORIZATIONS (PA) AND UTILIZATION MANAGEMENT
Most PAs should be requested online using Horizon BCBSNJ's online Utilization Management Request Tool. After logging into NaviNet.net, select Horizon BCBSNJ within the My Health Plans menu, mouse over Referrals and Authorization, then select Utilization Management Requests. PAs for PT/OT Services should also be requested using this online tool.
Outpatient Advanced Imaging and Pain Management
eviCore healthcare: 1-866-496-6200
Drug Authorizations
From NaviNet.net, select Horizon BCBSNJ within the My Health Plans menu and select Drug Authorizations
Alternate Request Methods
Prior Authorization Unit: 1-800-664-2583
HORIZON BEHAVIORAL HEALTH℠
1-800-626-2212
Unless otherwise noted on the member ID card, mail claim forms to:
PO Box 10191, Newark, NJ 07101-3189.
HORIZON CARE@HOME PROGRAM
Horizon BCBSNJ conducts the review of requests for:
Home Health Services (including in-home nursing services, physical therapy, occupational therapy and speech therapy).
Prior authorization requests for these services must be submitted using Horizon BCBSNJ’s online Utilization Management Request Tool via NaviNet. CareCentrix conducts the review of requests for Horizon Care@Home services for: Durable Medical Equipment (including Medical Foods [Enteral], and Diabetic and Other Medical Supplies); Orthotics and Prosthetics and Home Infusion Therapy Services, including hemophilia.
Call 1-855-243-3321 to initiate the review of these services.