Horizon Behavioral Health
September 23, 2019: New information available about the Horizon Behavioral Health℠ Program
As previously communicated, Horizon Blue Cross Blue Shield of New Jersey and Horizon NJ Health will transition the administration and clinical management of behavioral health services from Beacon Health Options (formerly ValueOptions) to our internal operations.
Additional information related to this transition is available for your review, including changes to:
- The credentialing of new behavioral health providers and ancillary facilities that wish to join one of our networks.
- How to update existing provider demographic information.
- The medical necessity criteria to be used to make utilization management determinations for behavioral health services.
- Review the provider announcement posted on May 30, 2019
- Review the Horizon Behavioral Health Management Change Frequently Asked Questions
Future announcements related to this transition will be posted online at horizonNJhealth.com/providernews. We strongly encourage behavioral health practitioners and employees of behavioral health facilities to regularly review the information at this location.
The Horizon Behavioral Health program is committed to providing our members with access to safe and effective care. The Horizon Behavioral Health program helps ensure medical and behavioral health services are integrated to help patients better manage all aspects of their health. We are focused on making sure our members get the right care when they need it.
About Horizon Behavioral Health (mental health/substance use)
Horizon NJ Health’s Behavioral Health program is committed to giving our members access to safe and effective care. The Horizon Behavioral Health program ensures medical and behavioral health services 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.
How members get help
To access behavioral health or substance use disorder resources, members can visit our award winning website, Achieve Solutions. Achieve Solutions offers comprehensive behavioral health and wellness resources for members and their families, so that they can make educated decisions about their health. This interactive site includes health assessments, personalized health tracking and extensive health research and learning tools. Educational information is also available, as well as tools to locate providers, community resources or child and elder care services through an interactive assistant.
Dedicated support 24/7
We are committed to getting members the support they need. Services are available 24 hours a day, seven days a week. Call the numbers below if you are a client or member of the following:
|Division of Developmental Disabilities (DDD)||1-800-682-9090 (TTY 711)|
|Managed Long Term Services and Supports (MLTSS)||1-844-444-4410 (TTY 711)|
|Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP)||1-800-543-5656 (TTY 711)|
Members not enrolled with DDD, MLTSS or FIDE-SNP should call their local Medical Assistance Customer Center (MACC) for mental health services. To find the number of a local MACC, call the NJ FamilyCare Hotline at 1-800-356-1561 (TTY 711). For addiction services and referrals, call the New Jersey Addiction Services Hotline at 1-844-276-2777 (TTY 711). You can also call 1-844-ReachNJ (1-844-732-2465).
Horizon Behavioral Health includes intensive care management services for members in the FIDE-SNP and MLTSS programs. All members can access emergency behavioral health services by calling 1-877-695-5612 (TTY 711).
The Horizon Behavioral Health Program is administered by Beacon Health Options, a New Jersey Corporation Licensed by the NJ Department of Banking & Insurance as an Organized Delivery System. Beacon Health Options is contracted by Horizon NJ Health to administer the Horizon Behavioral Health Program.
Members do not need a referral from their Primary Care Provider (PCP) to see a behavioral health provider. We encourage all providers to call us in advance of providing services to confirm the member’s eligibility, the in-network status of the facility and to verify benefits.
For prior-authorization requests and other related clinical questions, please call:
NJ FamilyCare: 1-800-682-9091
For authorization requests, please call within 24 hours of the admission and provide the reason for the admission, diagnosis, medication, treatment plan, discharge plan and any other pertinent information we would need for medical necessity review.
Authorization is available 24 hours a day, seven days a week. Non-Emergent Behavioral Health Services are available Monday to Friday from 8 a.m. to 5 p.m., Eastern Time.
For Substance Use services for individuals who are not Non-MLTSS, DDD and FIDE-SNP members, contact IME Addiction Access Center at 1-844-276-2777, 24 hours a day, seven days a week.
The following behavioral health services require prior-authorization:
Authorization is not required for outpatient services for in-network providers.
Please note, prior authorization and a single case agreement are required for out-of-network providers. Criteria for single case agreement will be discussed during the review for authorization.
- Review the provider announcement posted on May 30, 2019.
- Review the Horizon Behavioral Health Management Change Frequently Asked Questions.
- Inpatient Psychiatric Treatment
- Partial Hospitalization
- Partial Care
- Adult Mental Health Rehabilitation (AMHR) Group Homes and Apartments
- Psychological Testing
- Trans Magnetic Stimulation
- Short Term Residential Treatment (ASAM 3.7)
- Ambulatory Withdrawal Management (ASAM 2-WM)
- Medically Monitored Detox (SUD ASAM 3.7D)
- IOP SUD (ASAM 2.1)
- Partial SUD (ASAM 2.5)
- All out-of-network providers will require an authorization for any level of care including outpatient levels of care.