Table of Contents BCBSNC … On a quarterly basis, a Network Outreach Specialist will call practice locations to validate practice’s information. The physician data elements that are verified are: The online Doctor & Hospital Finder and on demand hardcopy provider directories are updated no greater than every 30 days. The Blue Cross Blue Shield System is made up of 36 independent and locally operated companies. Please click Continue to leave this website in order to access the Plan Comparison Tool where you can compare medical plan costs. ® 2021 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105. ® SM Registered and Service Marks of the Blue Cross and Blue Shield Association. You are now leaving Horizon Blue Cross Blue Shield's website for DSM employees. Or, click Cancel to remain on the current site. Need a form? With close to eight million members enjoying the benefits of these health insurance policies, Horizon is one of the most trusted names in the health care industry. Billing for Horizon Blue Cross Blue Shield of New Jersey Home Health Providers Overview General Billing Tips. 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. Or, click Cancel to remain on the current site. For J.D. Horizon Healthcare Services Inc., Horizon Healthcare of New Jersey, Inc. (Commercial), Braven Health℠ and Horizon NJ Health (HNJH), hereinafter collectively "Horizon BCBSNJ" will comply with all accreditation requirements, applicable laws, regulations and other communications from Federal and State regulatory bodies and accrediting agencies as described in the “Reference” Section of this policy. 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. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. Languages spoken at the office other than English. CMS Managed Care Manual 110.2 Provider Directory State Spot Check – Practitioners in the Medicaid and FIDE-SNP Networks only PCPs, Ob/Gyns and Specialists – Demographic changes and location terminations identified by the Provider Data Management Outreach Team will be reported to the Division of Medical Assistance and Health Services (DMAHS) by the 15th of each month. December. Register to attend one of our educational webinars. Visit Blue365. Horizon Blue Cross Blue Shield of NJ. The carrier’s website address where the electronic directory can be accessed. In the fight against coronavirus (COVID-19), Scalp Cooling Devices To Prevent Hair Loss During Chemotherapy, Genetic Testing for Cardiac Ion Channelopathies, Ablation Procedures for Peripheral Neuromas, Claims Payment Policies and Other Information. Leadership Perspectives. Horizon BCBSNJ will maintain a history of the electronic directories for three years. To see all available Qualified Health Plan options, go to the New Jersey Health Insurance Marketplace at Get Covered NJ. 02, 2020 | 08:37 AM America/New_York. Please contact the healthcare … Horizon Blue Cross Blue Shield (BCBSNJ) are helping residents of New Jersey by covering the costs of drug or alcohol rehab. Members are notified annually of the availability of the information in our Doctor & Hospital Finder and are provided with a reply card to request a printed directory. Address: address1 and address2 will be listed on two lines. The Braven Health℠ name and symbols are service marks of Braven Health. The vendor will create print on demand directories upon request from members, prospective members, network providers and/or internal departments. Physicians and other healthcare professionals that cannot be validated through NPPES will be contacted by phone to verify demographic information on a quarterly basis. Visit Blue365. The appropriate Contracting/Credentialing Department ensures that all required information is received to allow the contracting/credentialing team to conduct a complete review of the submitted information. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. This policy applies to processes that ensure that accurate participating provider network information is made available to members enrolled in all of the plans and products we offer, including QHP plans and products, in a reasonable timeframe through our online Doctor & Hospital Finder and our printed provider directories. Access My Benefits Changing Coverage? For J.D. Some delegated groups are NCQA accredited and have signed agreements to follow Horizon BCBSNJ credentialing administrative policy. These companies offer support for rehabilitation services, both in and out their networks. Horizon BCBSNJ accepts directory maintenance files to update demographic information and participation status of practitioners. Latest Covid Surge Means Doubling Down on Jersey Strong. 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. NCQA – Current Standards and Guidelines for the Accreditation of Health Plans You are now leaving Horizon Blue Cross Blue Shield's website for DSM employees. All are independent licensees of the Blue Cross and Blue Shield Association. These are just a … Dec 2012 – Present 7 years 8 months. 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. Please click Continue to leave this website. This website does not display all Qualified Health Plans available through Get Covered NJ. New Jerseyans need to be smart, stand strong and stand together. Applicable Products: American Well is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross and Blue Shield Association. Horizon BCBSNJ is committed to providing transparent information regarding the selection of physicians, other healthcare professionals, facilities and ancillary providers into networks that utilize tiering and/or a subset of an existing Horizon Network. References: Policymakers. Tags. Administrative Policy: Please click Continue to leave this website in order to access the Plan Comparison Tool where you can compare medical plan costs. On-call Horizon BCBSNJ support is always at your service to answer your questions or concerns. You are now leaving Horizon Blue Cross Blue Shield's website for DSM employees. ® Registered Marks are property of their respective owners. In the fight against coronavirus (COVID-19), we’re covering more of your patients’ costs and making their access to doctors and nurses easier. December. Learn more about Braven Health and your participation status. New Jersey's phased approach to administer COVID-19 vaccines to those who live, work or study in the state is now underway. Horizon BCBSNJ will provide print on demand directories upon request. Commercial HMO & POS, 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, Availability of Printed Directories and Web Based Provider Directory Information Through Alternate Media, Requests to Change Provider Directory Content via Electronic Media, Claims Payment Policies and Other Information. Our forms are located in one convenient location. The Horizon Blue app is free and lets you: • Access the details … The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. You can also chat with a nurse or see a doctor virtually directly on your 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. Statement that the directory was accurate as of the date it was submitted for publication. If you need help, we’ve created these helpful guides: Step-by-Step PDF; Search as Guest × Footer Skip to footer content. Providers. Please note, on the next page, only the information in the yellow box applies to DSM employees -- complete the information required. At Horizon Blue Cross Blue Shield of New Jersey, we’re proud to present the next generation of Blue365®, a new take on our valued program offering you exclusive health and wellness deals to keep you healthy and happy. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. Print on demand directories will be based on a geo-access radius from the requester’s zip code as follows: The geo-access radius can be customized or a complete provider directory can be printed upon request. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and … Provider demographic information will be sent to the contracted vendor on a monthly basis or more frequently as required. Visit bcbsnc.com for the most current listing, or call the Customer Service number on the back of your ID card. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. Provider Directory Management. You know what it takes to keep … This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. Horizon BCBSNJ will retain as business records copies of each version of its printed provider directory for at least three years from the publication date. ® 2021 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105. Applicable Products: Requests to Change Provider Directory Content via Electronic Media Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and … For information on more pharmacies in our plan network not listed in this directory please contact member services at 1-800-391-1906, for TTY/TDD users, 711. A participating Hospital/Ancillary/Professional initiates a request to change/update demographic information displayed the Doctor & Hospital Finder. This website does not display all Qualified Health Plans available through Get Covered NJ. Please call Member Services toll free at 1-800-682-9090 Call: 1-800-682-9090 (TTY/TDD 711) to request a copy. To see all available Qualified Health Plan options, go to the New Jersey Health Insurance Marketplace at Get Covered NJ. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Power 2020 award information, visit jdpower.com/awards. Back. In the fight against coronavirus (COVID-19), we’re covering more of your patients’ costs and making their access to doctors and nurses easier. You have until January 31, 2021 to apply for Individual health care coverage effective February 1, 2021. Review information about the Horizon Behavioral Health program. You have until January 31, 2021 to apply for Individual health care coverage effective February 1, 2021. BE100, 10/08. This policy documents the processes and procedures we have in place to ensure that accurate participating provider network data is made available to members enrolled in the plans we offer through the Doctor & Hospital Finder and printed provider directories. Dental Providers –Scion Dental aka SKYGEN USA is contracted by Horizon NJ Health to conduct outreach and provide results monthly in the required format that is reported to DMAHS by the 15th of each month. 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. Member Discounts Take advantage of member-only discounts on health-related products and services. Power 2020 award information, visit jdpower.com/awardsjdpower.com/awards opens a dialog window‌. Kimberly Ross Manager, Risk Adjustment Provider Education at Horizon Blue Cross Blue Shield of New Jersey Union, New Jersey 500+ connections The Blue Cross® and Blue Shield® names and symbols are … Please click Continue to leave this website in order to access the Plan Comparison Tool where you can compare medical plan costs. featured . You are now leaving Horizon Blue Cross Blue Shield's website for DSM employees. The Blue Cross Blue Shield System is made up of 36 independent and locally operated companies. 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. Upon receipt of the request, the appropriate department validates or makes the requested changes to the Hospital/Ancillary/Professional record in the appropriate provider files location/system within 20 days of receipt of request. 14, 2020 | 11:28 AM America/New_York. Review Blue Cross and Blue Advantage medical and pharmacy policies and guidelines or comment on draft policies. You are leaving the Horizon Blue Cross Blue Shield of New Jersey website. For J.D. Customer Service Representatives can provide information found in our Doctor & Hospital Finder via the telephone, print and mail a subset of the Doctor & Hospital Finder, or mail a printed copy of the entire directory. A new Hospital/Ancillary/Professional initiates/submits a request to become a Horizon BCBSNJ participating provider. Provider Data Management Outreach and Audit Program Marketplace Transparency Blue365's® exclusive deals, open only to Blue members, will bring you discounts at top health and wellness retailers around the country. The Hospital/Ancillary/Professional information submitted is reviewed by our Credentialing Committee and a determination is made to accept or deny the request for participation. ® Registered Marks of the Blue Cross and Blue Shield Association. Back. Global Coverage Member Discounts Find a … The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The physician record attestation date is equivalent to the outreach date. Please click Continue to leave this website in order to access the Plan Comparison Tool where you can compare medical plan costs. The Doctor & Hospital Finder and printed directories will contain the following fields for each provider as required by CMS, DOBI and NCQA: The electronic directories will be published in a JavaScript Object Notation (JSON) Format, also known as a machine readable format. 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. Purpose: Requests may be initiated via our online Demographic Update tool, by completing and submitting a copy of our File Change Request Form, or by submitting a letter on the practice’s or facilities letterhead. Or, click Cancel to remain on the current site. New Law Means Better Health Care Experience for You. Doctors & Specialists Primary Care Physician Facilities Dentists Vision Care MENTAL HEALTH ALTERNATIVE MEDICINE Pharmacies EQUIPMENT & SUPPLIES URGENT CARE . Quarterly Claim Editing Update: First Quarter 2021, Announcing the TurningPoint Safety and Quality Award Program for Orthopedic Specialists. 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. Exchange POS/EPO, Applicable Products: ® Registered Marks of Blue Cross Blue Shield of Massachusetts. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. COVID19. Learn more about Braven Health and your participation status. Once the file is completed, Hospital/Ancillary/Professional demographic information feeds automatically to the Doctor & Hospital Finder. This requirement may be met by establishing a capability of reconstructing a directory as of any date within the prior three years. 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. To access your member services, please visit your BCBS company. Or, click Cancel to remain on the current site. Hospital quality data from a recognized source. Electronic directories will also include search functionality to allow members to customize their provider search, including but not limited to, specialty and geographic area. The Credentialing Department creates a file within the appropriate internal system containing the demographic information pertaining to that Hospital/Ancillary/Professional. Policy: Find my BCBS company . American Well supports Horizon Blue Cross Blue Shield of New Jersey in the administration of telemedicine benefits. Practitioners may be unsuppressed by contacting Horizon BCBSNJ and requesting that Provider Data Management validate demographic information by calling the practice location directly. Horizon BCBSNJ does not credential physicians in delegated groups. Managed Care Network Provider Regulations 11:24C-4.5 Power 2020 award information, visit jdpower.com/awards. Blue Cross and Blue Shield of North Carolina is an independent licensee 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. A listing of the carrier’s in-network hospital outpatient facilities by the types of services the facilities provide and a statement urging members to confirm that outpatient providers practicing in network hospitals are participating. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Finding and Visiting a Doctor. Division of Medical Assistance and Health Services (DMAHS). Horizon BCBSNJ conducts a monthly audit on updated records. If Horizon BCBSNJ receives feedback regarding the content of our Doctor & Hospital Finder, we will research and update our files as needed. Exchange POS/EPO, Applicable Products: For questions on the … … 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. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and … Procedure for Creating a New Provider Directory File, Procedure for Existing Hospital/ Ancillary/ Professional Provider Directory Maintenance, Procedure to Ensure Accuracy of Provider Directories, Procedure to Ensure Accuracy of Medicare Advantage Provider Directories. … New Hospital/Ancillary/Professional information is displayed within the Doctor & Hospital Finder within 24 to 48 hours. 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. Directory Requirements The Braven Health℠ name and symbols are service marks of Braven Health. Member Discounts Take advantage of member-only discounts on health-related products and services. Category. The anticipated date on which the next printed edition will be published. 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. How to Enroll for a Health Plan ; Get a Quote/Browse and Buy … Online Provider Directory Features (OLI Document) Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and … This policy also helps ensure that the contents of the directories are fully compliant with all regulatory and accrediting requirements. January 31, 2021 to apply for Individual Health Care coverage horizon blue cross blue shield provider directory February 1, 2021 Jersey Strong alcohol. 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