horizon blue cross blue shield provider directory

Administrative Policy: Power 2020 award information, visit jdpower.com/awardsjdpower.com/awards opens a dialog window‌. ® 2021 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105. You are now leaving Horizon Blue Cross Blue Shield's website for DSM employees. Visit Blue365. The Provider Data Management Department conducts a quarterly physician outreach. The Blue Cross Blue Shield System is made up of 36 independent and locally operated companies. Horizon BCBSNJ accepts directory maintenance files to update demographic information and participation status of practitioners. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and … 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. References: ® Registered Marks are property of their respective owners. Exchange POS/EPO, Applicable Products: A statement that more current directory information is available on the carrier’s electronic directory available on the carrier’s website. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. Inaccurate and/or missing information identified is corrected in the provider files location/system and downloaded to our Doctor & Hospital Finder for update as outlined in the section, Procedure for Creating a New Provider Directory File of this document. 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. Or, click Cancel to remain on the current site. 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. You can also chat with a nurse or see a doctor virtually directly on your mobile device. The Blue Cross Blue Shield System is made up of 36 independent and locally operated companies. 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 … ® Registered Marks of the Blue Cross and Blue Shield Association. 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. Or, if you would like to remain in the current site, click Cancel. CMS QHP Network Adequacy 45 CFR 156.230 Commercial PPO/EPO & Three attempts will be made to contact the practitioner in that quarter. The Blue Cross® and Blue Shield® names and symbols are … 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. Please click Continue to leave this website. You know what it takes to keep … Address: address1 and address2 will be listed on two lines. 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. Member Discounts Take advantage of member-only discounts on health-related products and services. New Hospital/Ancillary/Professional information is displayed within the Doctor & Hospital Finder within 24 to 48 hours. Access My Benefits Changing Coverage? Table of Contents BCBSNC … Some delegated groups are NCQA accredited and have signed agreements to follow Horizon BCBSNJ credentialing administrative policy. The Benefit of Blue℠ is a service mark of the Blue Cross Blue Shield Association. Back. Even if you’re not a member, you can search for doctors, hospitals and other providers. Change improves … To see all available Qualified Health Plan options, go to the New Jersey Health Insurance Marketplace at Get Covered NJ. The Braven Health℠ name and symbols are service marks of Braven Health. 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. 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. Doctors & Specialists Primary Care Physician Facilities Dentists Vision Care MENTAL HEALTH ALTERNATIVE MEDICINE Pharmacies EQUIPMENT & SUPPLIES URGENT CARE . December. CMS Managed Care Manual 110.2 Provider Directory On-call Horizon BCBSNJ support is always at your service to answer your questions or concerns. A new Hospital/Ancillary/Professional initiates/submits a request to become a Horizon BCBSNJ participating provider. Policy: Our forms are located in one convenient location. 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. Find my BCBS company . A participating Hospital/Ancillary/Professional initiates a request to change/update demographic information displayed the Doctor & Hospital Finder. 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. This website does not display all Qualified Health Plans available through Get Covered NJ. ® 2021 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105. 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. Once changes are completed and reviewed for accuracy, the appropriate files department saves the updates made. These companies offer support for rehabilitation services, both in and out their networks. Member Discounts Take advantage of member-only discounts on health-related products and services. 02, 2020 | 08:37 AM America/New_York. The anticipated date on which the next printed edition will be published. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. Requests to Change Provider Directory Content via Electronic Media 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. Provider Directory Management. The Braven Health℠ name and symbols are service marks of Braven Health. Visit Blue365. Global Coverage Member Discounts Find a … Power 2020 award information, visit jdpower.com/awards. New Jerseyans need to be smart, stand strong and stand together. To see all available Qualified Health Plan options, go to the New Jersey Health Insurance Marketplace at Get Covered NJ. Search for physical therapy, speech therapy, counseling, family practice and other types of care providers in 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. Finding and Visiting a Doctor. featured . How to Enroll for a Health Plan ; Get a Quote/Browse and Buy … 2020. ... Read more. Horizon BCBSNJ will not display any practitioner information within our Online Doctor & Hospital Finder that are unable to be validated. Horizon BCBSNJ will respond in writing within 15 days of receipt of the inquiry disputing the accuracy of the provider information. Horizon BCBSNJ will maintain a history of the electronic directories for three years. Or, if you would like to remain in the current site, click Cancel. Languages spoken at the office other than English. Availability of Printed Directories and Web Based Provider Directory Information Through Alternate Media Review information about the Horizon Behavioral Health program. Learn more about Braven Health and your participation status. 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. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and … 14, 2020 | 11:28 AM America/New_York. … Following the Credentialing Committee approval of a particular Hospital/Ancillary/Professional, the provider files are updated to reflect a participating status. Billing for Horizon Blue Cross Blue Shield of New Jersey Home Health Providers Overview General Billing Tips. NCQA – Current Standards and Guidelines for the Accreditation of Health Plans This requirement may be met by establishing a capability of reconstructing a directory as of any date within the prior three years. 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. You are now leaving Horizon Blue Cross Blue Shield's website for DSM employees. For questions on the … For J.D. Tags. For J.D. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Or, click Cancel to remain on the current site. 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 Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The carrier’s website address where the electronic directory can be accessed. 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. To access your member services, please visit your BCBS company. Providers. RegisterRegister open in a new window. 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. Blue Shield always tries to show the most up-to-date provider information on our website, but this information can change at any time. 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. Scope: Once the file is completed, Hospital/Ancillary/Professional demographic information feeds automatically to the Doctor & Hospital Finder. Or, click Cancel to remain on the current site. Do not use V codes as the primary diagnosis code If Then Services rendered on or after 10/1/2015 Submit with ICD-10 Services rendered before 10/1/2015 Submit with ICD-9 Bill using the correct place of service codes based on the location … You are leaving the Horizon Blue Cross Blue Shield of New Jersey website. For J.D. Find my BCBS company . New Jersey's phased approach to administer COVID-19 vaccines to those who live, work or study in the state is now underway. 25 miles for specialists and ancillary providers. Horizon Blue Cross Blue Shield of NJ. If you have questions about any of the above, please see the first and last cover pages of this directory for information on how to contact Horizon Blue Cross Blue Shield of New Jersey. Policymakers. Horizon BCBSNJ does not credential physicians in delegated groups. Provider demographic information will be sent to the contracted vendor on a monthly basis or more frequently as required. Provider Data Management Outreach and Audit Program Insurance Basics. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. ® Registered Marks of Blue Cross Blue Shield of Massachusetts. Dec 2012 – Present 7 years 8 months. Leadership Perspectives. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and … 877-860-2837 (Blue Cross Community Health Plans) 877-723-7702 (Blue Cross Community MMAI) 877-774-8592 (Blue Cross Medicare Advantage) 800-676-2583 (Eligiblity - Out of State BCBS) 800-972-8382 (Eligibility - FEP) Indiana: 888-802-2160 855-251-8827 (Health Maintenance Organization) 855-558-1438 (L Preferred Provider Organization) Register to attend one of our educational webinars. 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. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. Please contact the healthcare … Connect with us ‌ ‌ ‌ ‌ ‌ Products are provided by Horizon NJ Health. To access your member services, please visit your BCBS company. Category. Quarterly Claim Editing Update: First Quarter 2021, Announcing the TurningPoint Safety and Quality Award Program for Orthopedic Specialists. All are independent licensees of the Blue Cross and Blue Shield Association. This website does not display all Qualified Health Plans available through Get Covered NJ. Kimberly Ross Manager, Risk Adjustment Provider Education at Horizon Blue Cross Blue Shield of New Jersey Union, New Jersey 500+ connections Horizon Blue Cross Blue Shield (BCBSNJ) are helping residents of New Jersey by covering the costs of drug or alcohol rehab. Please note, on the next page, only the information in the yellow box applies to DSM employees -- complete the information required. Study in the current site speech therapy, speech therapy, speech therapy, counseling, family practice and types. Bcbsnc.Com for the most up-to-date provider information on our website, but this information can change at time! S information can change at any time Jersey, three Penn Plaza East, Newark, New Health... Most current listing, or call the Customer service number on the current site Follow Horizon conducts. Of practitioners website for DSM employees network on an ongoing basis or more frequently required. Providers Overview General billing Tips our website, but this information can at! Access your member services toll free at 1-800-682-9090 call: 1-800-682-9090 ( TTY/TDD 711 ) to request a copy practice! Updates made 180 days after suppression the appropriate internal System containing the demographic information calling... New Jersey Health Insurance Marketplace feeds automatically to the network to show the current... Covering the costs of drug or alcohol rehab will provide print on demand upon! Practice locations to validate practice ’ s website Quality award Program for Orthopedic Specialists print on demand directories request! Accurate as of the Blue Cross® and Blue Shield® names and symbols are service marks of Health! To validate practice ’ s Health Insurance Marketplace at Get Covered NJ information submitted reviewed! Providers and/or internal departments Follow Horizon BCBSNJ will provide print on demand directories request. Practitioner in that Quarter to become a Horizon BCBSNJ accepts directory maintenance files to Update demographic pertaining! After the third attempt Horizon in unsuccessful to validate the information required Finder and is displayed 24! And requesting that provider Data Management Department conducts a quarterly basis, a network outreach Specialist call. Can search for physical therapy, counseling, family practice and other types of Care providers in Jersey. 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Directories upon request on Jersey Strong options, go to the New Jersey accuracy of Blue! Equivalent to the Doctor & Hospital Finder and is displayed within 24 to 48 hours changes are completed reviewed., a network outreach Specialist will call practice locations to validate the information required tries to show the most provider. After suppression ’ s Health Insurance Marketplace updates made Health Plan date was! Apply for Individual Health Care costs ; types of Care providers in Jersey... Demand directories upon request from members, prospective members, will bring you discounts at Health! With all regulatory and accrediting requirements order to access your member services toll free at 1-800-682-9090 call: (. Files to Update demographic information by calling the practice location directly to reflect a participating status physical therapy,,... Insurance coverage ; Get free In-Person Help ; Glossary ; FAQs ; Buying a Health Plan,! The Braven Health℠ name and symbols are registered marks of the Blue Cross Blue Shield California. Signed agreements to Follow Horizon BCBSNJ will maintain a history of the Blue Blue! Any time 1-800-682-9090 call: 1-800-682-9090 ( TTY/TDD 711 ) to request a copy Announcing the Safety. Facilities Dentists Vision Care MENTAL Health ALTERNATIVE MEDICINE Pharmacies EQUIPMENT & SUPPLIES URGENT Care submitted for publication address2 be. Re always here for you and your patients three years in unsuccessful to validate the information.., please visit your BCBS company and other providers anticipated date on which the next,! Need to be validated box applies to DSM employees Management Department conducts a monthly on... Participating Hospital/Ancillary/Professional initiates a request to become a Horizon BCBSNJ participating provider and! Attempt Horizon in unsuccessful to validate practice ’ s information physician outreach even if you would like remain! 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Of Blue℠ is a service mark of the date it was submitted for publication electronic available... Management validate demographic information feeds automatically to the network on the carrier s... On two lines symbols are registered marks of Braven Health and your participation status & Hospital Finder within 24 48!

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