Doula Services Providers

Horizon NJ Health invites New Jersey-based Doula Services providers to join our vast network of participating professionals, as we continue to provide the highest level of service and care for our members.

Doula Services providers who are enrolled with New Jersey Medicaid are eligible to participate in our network to treat members enrolled in Horizon NJ Health Medicaid plans – including Division of Developmental Disabilities (DDD), NJ FamilyCare and Managed Long Term Services & Supports (MLTSS).

To be considered for participation in our network, we must assess your credentials and ensure that you meet all criteria for participation.

For instructions on how to submit a request to participate in our network, review our Doula Services Provider Credentialing Application Checklist.

Please always verify your Horizon NJ Health patients’ eligibility and benefits to ensure you understand the services covered under their plan.

21st Century Cures Act

All providers who would like to participate in our Horizon NJ Health networks are required to register with the State of New Jersey under the 21st Century Cures Act. Providers who cannot provide us with proof of their registration under the 21st Century Cures Act will not be approved for participation in our network.

Learn more about the 21st Century Cures Act.

Group Agreements

  • If your professional group practice wishes to participate in the Horizon NJ Health networks under a Group Agreement, please email a request to HNJHProvider_Recruitment@HorizonBlue.com.
  • If you wish to have new practitioners credentialed and added to the group roster of your group practice that already participates in the Horizon NJ Health networks under a Group Agreement, please draft a letter on your group practice’s letterhead authorizing the inclusion of these practitioner(s) and enclose the each practitioner’s CAQH #.

    Please forward this information to:
    • By email:
      EnterprisePDM@HorizonBlue.com
      (email submission will be accepted only for the duration of the COVID-19 public health emergency)
    • By mail:
      Horizon BCBSNJ Credentialing/Recredentialing Dept.
      3 Penn Plaza East, PP-14C
      Newark, NJ 07105-2200
Tikka Attach

Doula Services Provider
Credentialing Application Checklist

40071 (0321) Products are provided by Horizon Healthcare Services, Inc. d/b/a Horizon BCBSNJ, Horizon Healthcare of New Jersey, Inc. (d/b/a Horizon NJ Health for Medicaid
line of business), Horizon Insurance Company and Healthier New Jersey Insurance Company d/b/a Braven Health. Communications are issued by Horizon
Healthcare Services, Inc. d/b/a Horizon BCBSNJ in its capacity as administrator of programs and provider relations for all of its companies. Both are independent
licensees of the Blue Cross and Blue Shield Association. ?2021 Horizon BCBSNJ, Three Penn Plaza East, Newark, New Jersey 07105

Thank you for your interest in joining our Horizon NJ Health network as a Doula Services Provider. Below is an overview
of our process: what you need to do, and what you can expect from us as you proceed through our credentialing process.

STEP 1 So that we may assess your credentials and ensure that you meet the criteria for participation in
our Horizon NJ Health network, please complete/gather the information noted below.

? Complete and sign a copy of the NJ Universal Physician Credentialing Form.
Please note that we display the practitioner location information you include in the
NJ Universal Physician Credentialing Form on our online Doctor & Hospital Finder
and in our printed provider directories.

? Complete a copy of our Horizon BCBSNJ Provider Network Special Needs Survey.

? Provide a copy of the letter from the State of New Jersey (or other documentation)
showing proof of your enrollment in FFS NJ FamilyCare (Medicaid) that includes your
Medicaid ID number and effective date.

? Provide a copy of your current malpractice insurance certificate face sheet from a
carrier authorized to issue policies for the state of New Jersey. The face sheet must
display your name, the effective date of the policy, expiration date and the coverage
limits. A minimum of $1 million per occurrence and $3 million aggregate is required.

? Review, complete and sign a copy of our Horizon Government Programs Doula
Services Provider Agreement.

Please email Doula_Credentialing_&_Servicing@HorizonBlue.com to request a copy
of our Horizon Government Programs Doula Services Provider Agreement.

STEP 2 Please submit your completed package of information to us.
By mail to: Horizon BCBSNJ Credentialing & Recredentialing Dept.

3 Penn Plaza East, PP-14C
Newark, NJ 07105-2200

Or, for the duration of the COVID-19 public health emergency, email your completed package
of information to EnterprisePDM@horizonblue.com

STEP 3 Our Credentialing Department will send a written notice to advise you that we received your
information.

? Applications that do not include all required information will be withdrawn and require
you to submit a new Application.

STEP 4 Our process may take up to 60 days from the date that we have all required information.

? We will send you a written response to advise if your Application has been denied.
? If you have not received a written response about your Application after 60 days, you

may email an inquiry to PCS_Credentialing_Mailbox@horizonblue.com for the status.

STEP 5 Once your application has been approved, we will mail you a letter that includes:

? Your participation effective date
? Instructions to access a welcome kit of important information and our provider manual.
? Copies of your fully executed Agreement

Questions If you have questions, please email us at PCS_Credentialing_Mailbox@horizonblue.com


NJ Universal App:
Special Needs:
Documentation:
Insurance:
Agreement:
RESET: