Toggle menu
- BACKback to www.horizonblue.com
- PROVIDERS
-
ResourcesResources
- Resources
- Adolescent Risk Behaviors and Depression PIP HandbookAdolescent Risk Behaviors and Depression PIP Handbook
- Advance DirectivesAdvance Directives
- ASAM Criteria for Patients and FamiliesASAM Criteria for Patients and Families
- Clinical and Preventive GuidelinesClinical and Preventive Guidelines
-
Credentialing and Recredentialing ResponsibilitiesCredentialing and Recredentialing Responsibilities
- Credentialing and Recredentialing Responsibilities
- Credentialing and Recredentialing Policy for Participating Physicians and Healthcare ProfessionalsCredentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals
- Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) ProvidersCredentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers
- Cultural CompetencyCultural Competency
- Demographic updatesDemographic updates
-
Educational Material for ProvidersEducational Material for Providers
- Educational Material for Providers
- ClaimsXTen FAQsClaimsXTen FAQs
- ClaimsXTen Edit Codes and MessagesClaimsXTen Edit Codes and Messages
- CareAffiliate TrainingCareAffiliate Training
- SimpleClaim Training ResourcesSimpleClaim Training Resources
- How to Correctly Submit Claims with J or Q CodesHow to Correctly Submit Claims with J or Q Codes
-
FormsForms
- Forms
- Age - Appropriate EPSDT FormsAge - Appropriate EPSDT Forms
- FormsForms
- Nurse PractitionerNurse Practitioner
- Physician AssistantPhysician Assistant
- PhysicianPhysician
- Ancillary ProviderAncillary Provider
- Physical Therapist, Occupational Therapist, Speech TherapistPhysical Therapist, Occupational Therapist, Speech Therapist
- Electronic Funds Transfer (EFT) FormsElectronic Funds Transfer (EFT) Forms
- Clinical Authorization FormsClinical Authorization Forms
- Lead Risk AssessmentLead Risk Assessment
- GuidesGuides
- Health LiteracyHealth Literacy
-
Laboratory Corporation of America (LabCorp)Laboratory Corporation of America (LabCorp)
- Laboratory Corporation of America (LabCorp)
- LabCorp Alert and Panic Results PolicyLabCorp Alert and Panic Results Policy
- LabCorp Connectivity SolutionsLabCorp Connectivity Solutions
- LabCorp introduces RoadNet<sup>®</sup>LabCorp introduces RoadNet<sup>®</sup>
- LabCorp Beacon<sup>TM</sup>: PatientLabCorp Beacon<sup>TM</sup>: Patient
- NuSwab: Candida and STD testingNuSwab: Candida and STD testing
- Medicaid Reimbursement and BillingMedicaid Reimbursement and Billing
- MLTSS Non-Medical Professional Provider ManualMLTSS Non-Medical Professional Provider Manual
- MLTSS OrientationMLTSS Orientation
- eviCore healthcareeviCore healthcare
- NJ Addiction Services HotlineNJ Addiction Services Hotline
- Pharmacy Utilization Management ProgramsPharmacy Utilization Management Programs
-
PoliciesPolicies
- Policies
- Medical PoliciesMedical Policies
-
Reimbursement Policies & GuidelinesReimbursement Policies & Guidelines
- Reimbursement Policies & Guidelines
- Allergy ImmunotherapyAllergy Immunotherapy
- Ambulance ServicesAmbulance Services
- Billing Requirements for Clinical TrialsBilling Requirements for Clinical Trials
- Chiropractic Manipulation Diagnosis PolicyChiropractic Manipulation Diagnosis Policy
- Claim Editing PolicyClaim Editing Policy
- Daily Maximum Units for Surgical Pathology and Microscopic ExaminationDaily Maximum Units for Surgical Pathology and Microscopic Examination
- Diabetic Screening ServicesDiabetic Screening Services
- Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo or Myocardial Profusion ImagingEvaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo or Myocardial Profusion Imaging
- Foot Orthotic Shoes and InsertsFoot Orthotic Shoes and Inserts
- Frequency of Ocular PhotographyFrequency of Ocular Photography
- Laboratory Services Billed by PhysiciansLaboratory Services Billed by Physicians
- Maximum Units Policy on Hearing Aid BatteriesMaximum Units Policy on Hearing Aid Batteries
- Modifier JW – Drug WasteModifier JW – Drug Waste
- Modifier 22 – Increased Procedural ServicesModifier 22 – Increased Procedural Services
- Modifier 50 – Bilateral and LT/RTModifier 50 – Bilateral and LT/RT
- Modifier 52 – Reduced ServicesModifier 52 – Reduced Services
- Modifier 53 – Discontinued ProceduresModifier 53 – Discontinued Procedures
- Modifier 54 – Surgical Care OnlyModifier 54 – Surgical Care Only
- Modifier 55 – Postoperative Management OnlyModifier 55 – Postoperative Management Only
- Modifier 56 – Preoperative Management OnlyModifier 56 – Preoperative Management Only
- Modifier 57 – Decision for SurgeryModifier 57 – Decision for Surgery
- Modifier 62 – Two SurgeonsModifier 62 – Two Surgeons
- Modifier 66- Surgical TeamModifier 66- Surgical Team
- Modifier 76- Repeat Procedure or Service by Same PhysicianModifier 76- Repeat Procedure or Service by Same Physician
- Modifier 77- Repeat Procedure or Service by Another PhysicianModifier 77- Repeat Procedure or Service by Another Physician
- Modifier 78 – Unplanned Return to the ORModifier 78 – Unplanned Return to the OR
- Modifiers 80, 81, 82 and AS – Assistant SurgeonModifiers 80, 81, 82 and AS – Assistant Surgeon
- Multiple Procedure ReductionMultiple Procedure Reduction
- Multiple Procedure Payment Reduction for EndoscopiesMultiple Procedure Payment Reduction for Endoscopies
- Mutually and Non-Mutually Exclusive NCCI EditsMutually and Non-Mutually Exclusive NCCI Edits
- Preventative Medicine Services with Auditory ScreeningPreventative Medicine Services with Auditory Screening
- Pulmonary Diagnostic Procedures when billed with Evaluation and Management CodesPulmonary Diagnostic Procedures when billed with Evaluation and Management Codes
- Readmission Policy (Medicaid)Readmission Policy (Medicaid)
- Readmission Policy (Medicaid) – FAQReadmission Policy (Medicaid) – FAQ
- Telemedicine and TelehealthTelemedicine and Telehealth
- Ulcer Debridement and Ulcer StagesUlcer Debridement and Ulcer Stages
- Health Services Policies – Clinical Affairs, Dental, Pharmacy, Quality, Utilization ManagementHealth Services Policies – Clinical Affairs, Dental, Pharmacy, Quality, Utilization Management
- Provider NewsletterProvider Newsletter
- Provider ManualProvider Manual
- State of New Jersey Contractual RequirementsState of New Jersey Contractual Requirements
-
Timely Filing RequirementsTimely Filing Requirements
- Timely Filing Requirements
- Billing GuideBilling Guide
- Electronic Data Interchange (EDI)/Electronic Funds Transfer (EFT)Electronic Data Interchange (EDI)/Electronic Funds Transfer (EFT)
- Emdeon Electronic Funds Transfer (EFT) FormsEmdeon Electronic Funds Transfer (EFT) Forms
- Claims AddressesClaims Addresses
- ClaimsXTen FAQsClaimsXTen FAQs
- Tips for Claims/Encounters FilingTips for Claims/Encounters Filing
- NIA Claims MatrixNIA Claims Matrix
- False Claims PolicyFalse Claims Policy
- Utilization ManagementUtilization Management
- MLTSS Bed Type Revenue CodesMLTSS Bed Type Revenue Codes
- Well-Being Screening ToolWell-Being Screening Tool
- FAQ for MUE NotificationFAQ for MUE Notification
- MUE Rule Notification Letter MedicaidMUE Rule Notification Letter Medicaid
-
ProgramsPrograms
- Programs
- DentalDental
- Disease Management Programs to Help Your PatientsDisease Management Programs to Help Your Patients
- Education OpportunitiesEducation Opportunities
- Fluoride Varnish Pediatric ApplicationFluoride Varnish Pediatric Application
- Focus on Risk AdjustmentFocus on Risk Adjustment
-
Horizon Behavioral Health℠Horizon Behavioral Health℠
- Horizon Behavioral Health℠
- About the Horizon Behavioral Health ProgramAbout the Horizon Behavioral Health Program
- Credentialing & RecredentialingCredentialing & Recredentialing
- Demographic UpdatesDemographic Updates
- Medical Necessity CriteriaMedical Necessity Criteria
- Prior AuthorizationPrior Authorization
- Frequently Asked QuestionsFrequently Asked Questions
- External ResourcesExternal Resources
-
Horizon NJ TotalCare (HMO D-SNP)Horizon NJ TotalCare (HMO D-SNP)
- Horizon NJ TotalCare (HMO D-SNP)
- Educational WebinarsEducational Webinars
- Cognitive ImpairmentCognitive Impairment
- Balance BillingBalance Billing
- FIDE-SNP Quick Reference GuideFIDE-SNP Quick Reference Guide
- Member BenefitsMember Benefits
- Medicaid EligibilityMedicaid Eligibility
- Model of CareModel of Care
- Critical IncidentsCritical Incidents
- HEDISHEDIS
- Results & Recognition ProgramResults & Recognition Program
- VRIVRI
- Managed Long Term Services and SupportsManaged Long Term Services and Supports
- Mom's GEMS Prenatal ProgramMom's GEMS Prenatal Program
- Office Based Addiction Treatment (OBAT) ProgramOffice Based Addiction Treatment (OBAT) Program
- Primary Care Physician ProgramPrimary Care Physician Program
-
Quality Improvement ProgramQuality Improvement Program
- Quality Improvement Program
- Results & Recognition ProgramResults & Recognition Program
- Smoking CessationSmoking Cessation
- HEDIS®HEDIS®
- CAHPS (Consumer Assessment of Healthcare Providers and Systems)CAHPS (Consumer Assessment of Healthcare Providers and Systems)
- Progress Toward HNJH’s GoalsProgress Toward HNJH’s Goals
- Hospital Acquired Conditions and Serious Adverse EventsHospital Acquired Conditions and Serious Adverse Events
- Provider RecruitmentProvider Recruitment
- NewsNews
- FIND A DOCTOR
- MEMBER SIGN IN
-
Resources
- For Providers: 1-800-682-9091
-
Programs
- For Providers: 1-800-682-9091
-
Provider Recruitment
- For Providers: 1-800-682-9091
-
News
- For Providers: 1-800-682-9091
Provider Application Request - Horizon NJ Health
Are you sure you want to leave this website?
You are leaving the Horizon NJ Health website. Please click Continue to leave this website. Or, if you would like to remain in the current site, click Cancel.