Demographic updates

How to update your information with Horizon NJ Health

Please provide a letter, including submitter’s name, outlining your request along with the following documentation 30 days prior to the effective date of the requested change(s):

Type of request Documentation required Comments
Relocation or add new location
  1. Communication from provider
  2. List of providers
  3. W-9
  4. Americans with Disabilities Act (ADA) survey
Specify whether you are closing an existing office and/or adding an additional location.
Add provider to new location/group
  1. Communication from provider
  2. List of location(s)
  3. W-9
  4. ADA survey for new location
 
Close or open panel
  1. Communication from provider
There is a 90-day waiting period, per policy. Provider must have at least 50 members. We do not close panels for specialists.
Update other demographics (e.g., hours, phone, fax, suite, languages, age limits, panel limit)
  1. Communication from provider
If updating a suite, verify if site visit is needed (required for new locations for PCPs and Ob/Gyns).
TIN change or purchase of another entity
  1. Communication from provider
  2. W-9
  3. List of providers
Note whether you are assuming liability of prior TIN.
Billing and remittance change
  1. Communication from provider
  2. W-9
Be sure the billing address is not a PO Box; must be a physical location.
Termination from location/group
  1. Communication from provider
Advise where paneled members should be moved/transferred, if applicable (for PCPs only).

Email your request and supporting documentation to EnterprisePDM@HorizonBlue.com or mail to:

Horizon BCBSNJ Provider Files
3 Penn Plaza East, PP-14C
Newark, NJ 07105-2200