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    • Members Will Incur No Costs for Treatment of COVID-19Members Will Incur No Costs for Treatment of COVID-19
    • Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility AdmissionsWaiving 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 ProfessionalsHorizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health Professionals
    • Reminder to use specific codes when evaluating for COVID-19Reminder to use specific codes when evaluating for COVID-19
    • Administrative Policy: Credentialing and Recredentialing During the COVID-19 PandemicAdministrative Policy: Credentialing and Recredentialing During the COVID-19 Pandemic
    • Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissionsWaiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions
    • Referrals no longer required for in-network specialistsReferrals no longer required for in-network specialists
    • Governor suspends all elective proceduresGovernor suspends all elective procedures
    • New benefit: Applied Behavior Analysis servicesNew benefit: Applied Behavior Analysis services
    • Providing telephonic care with no costs to membersProviding telephonic care with no costs to members
    • COVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine ServicesCOVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine Services
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    • State of Emergency and Public Health Emergency – Office ClosuresState of Emergency and Public Health Emergency – Office Closures
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      • LabCorp introduces RoadNet<sup>®</sup>LabCorp introduces RoadNet<sup>®</sup>
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      • Horizon NJ Health Foot Orthotic Shoes and Inserts Reimbursement PolicyHorizon NJ Health Foot Orthotic Shoes and Inserts Reimbursement Policy
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        • Modifier JW – Drug WasteModifier JW – Drug Waste
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  • COVID-19 Information
      • For Providers: 1-800-682-9091

    • Behavioral Health Continuity During the COVID-19 Public Health Emergency

      COVID-19 Frequently Asked Questions

      Members Will Incur No Costs for Treatment of COVID-19

      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

      Reminder to use specific codes when evaluating for COVID-19

      Administrative Policy: Credentialing and Recredentialing During the COVID-19 Pandemic

      Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions

      Referrals no longer required for in-network specialists

      Governor suspends all elective procedures

      New benefit: Applied Behavior Analysis services

      Providing telephonic care with no costs to members

      COVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine Services

      COVID-19 CPT testing codes

      State of Emergency and Public Health Emergency – Office Closures

      Telemedicine and Telehealth Services Reimbursement Policy

      Eliminating Cost Sharing Related to COVID-19 Testing and Evaluation

      Staying Informed: COVID-19 (Coronavirus)

  • Resources
      • For Providers: 1-800-682-9091

    • Adolescent Risk Behaviors and Depression PIP Handbook

      Advance Directives

      ASAM Criteria for Patients and Families

      Clinical and Preventive Guidelines

      Credentialing and Recredentialing Responsibilities

      Cultural Competency

      Demographic updates

      Educational Material for Providers

      eviCore healthcare

      FAQ for MUE Notification

      Forms

      Guides

      Health Literacy

      Laboratory Corporation of America (LabCorp)

      Medicaid Reimbursement and Billing

      MLTSS Bed Type Revenue Codes

      MLTSS Non-Medical Professional Provider Manual

      MLTSS Orientation

      MUE Rule Notification Letter Medicaid

      NJ Addiction Services Hotline

      Pharmacy Utilization Management Programs

      Policies

      Provider Manual

      Provider Newsletter

      State of New Jersey Contractual Requirements

      Timely Filing Requirements

      Utilization Management

      Well-Being Screening Tool

  • Programs
      • For Providers: 1-800-682-9091

    • Dental

      Disease Management Programs to Help Your Patients

      Education Opportunities

      Fluoride Varnish Pediatric Application

      Focus on Risk Adjustment

      Horizon Behavioral Health℠

      Horizon NJ TotalCare (HMO D-SNP)

      Managed Long Term Services and Supports

      Mom's GEMS Prenatal Program

      Office Based Addiction Treatment (OBAT) Program

      Primary Care Physician Program

      Quality Improvement Program

  • Provider Recruitment
      • For Providers: 1-800-682-9091

    • Join the Horizon NJ Health Provider Network

      Ancillary Application Request

  • News
      • For Providers: 1-800-682-9091

    • Updates and Announcements

Clinical Authorization Forms - Horizon NJ Health

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COVID-19
Stay informed.Get the latest information on COVID-19.
Adolescent Risk Behaviors and Depression PIP Handbook
Advance Directives
ASAM Criteria for Patients and Families
Clinical and Preventive GuidelinesClinical and Preventive Guidelines
Clinical Guidelines
Credentialing and Recredentialing ResponsibilitiesCredentialing and Recredentialing Responsibilities
Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals
Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers
Cultural Competency
Demographic updates
Educational Material for ProvidersEducational Material for Providers
ClaimsXTen FAQs
ClaimsXTen Edit Codes and Messages
CareAffiliate Training
SimpleClaim Training Resources
How to Correctly Submit Claims with J or Q Codes
eviCore healthcare
FAQ for MUE Notification
FormsForms
Age - Appropriate EPSDT Forms
Forms
Nurse Practitioner
Physician Assistant
Physician
Ancillary Provider
Physical Therapist, Occupational Therapist, Speech Therapist
Electronic Funds Transfer (EFT) Forms
Clinical Authorization Forms
Lead Risk Assessment
Guides
Health LiteracyHealth Literacy
Resource Links
Tips and Tools
Laboratory Corporation of America (LabCorp)Laboratory Corporation of America (LabCorp)
LabCorp Alert and Panic Results Policy
LabCorp Connectivity Solutions
LabCorp introduces RoadNet®
LabCorp BeaconTM: Patient
NuSwab: Candida and STD testing
Medicaid Reimbursement and BillingMedicaid Reimbursement and Billing
Medicaid Provider Enrollment Requirements by State
Horizon NJ Health Foot Orthotic Shoes and Inserts Reimbursement Policy
MLTSS Bed Type Revenue Codes
MLTSS Non-Medical Professional Provider Manual
MLTSS Orientation
MUE Rule Notification Letter Medicaid
NJ Addiction Services Hotline
Pharmacy Utilization Management ProgramsPharmacy Utilization Management Programs
Pharmacy Medical Necessity Determination
Maximum Allowable Cost (MAC) Appeal Form
PoliciesPolicies
Medical Policies
Reimbursement Policies & Guidelines Reimbursement Policies & Guidelines
Advance Care Planning
Allergy Services
Ambulance Services
Billing Requirements for Clinical Trials
Chiropractic Manipulation Diagnosis Policy
Claim Editing Policy
Daily Maximum Units for Surgical Pathology and Microscopic Examination
Diabetic Screening Services
Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo or Myocardial Profusion Imaging
Foot Orthotic Shoes and Inserts
Frequency of Ocular Photography
Laboratory Services Billed by Physicians
Maximum Units Policy on Hearing Aid Batteries
Modifier JW – Drug Waste
Modifier 22 – Increased Procedural Services
Modifier 50 – Bilateral and LT/RT
Modifier 52 – Reduced Services
Modifier 53 – Discontinued Procedures
Modifier 54 – Surgical Care Only
Modifier 55 – Postoperative Management Only
Modifier 56 – Preoperative Management Only
Modifier 57 – Decision for Surgery
Modifier 62 – Two Surgeons
Modifier 66- Surgical Team
Modifier 76- Repeat Procedure or Service by Same Physician
Modifier 77- Repeat Procedure or Service by Another Physician
Modifier 78 – Unplanned Return to the OR
Modifiers 80, 81, 82 and AS – Assistant Surgeon
Multiple Procedure Reduction
Multiple Procedure Payment Reduction for Endoscopies
Mutually and Non-Mutually Exclusive NCCI Edits
Preventive Medicine Services
Preventative Medicine Services with Auditory Screening
Pulmonary Diagnostic Procedures when billed with Evaluation and Management Codes
Readmission Policy (Medicaid)
Readmission Policy (Medicaid) – FAQ
Telemedicine and Telehealth Telemedicine and Telehealth
Telemedicine Reimbursement Policy: Temporary Update
Transitional Care Planning
Ulcer Debridement and Ulcer Stages
Health Services Policies – Clinical Affairs, Dental, Pharmacy, Quality, Utilization Management
Provider Manual
Provider Newsletter
State of New Jersey Contractual Requirements
Timely Filing RequirementsTimely Filing Requirements
Billing Guide
Electronic Data Interchange (EDI)/Electronic Funds Transfer (EFT)
Emdeon Electronic Funds Transfer (EFT) Forms
Claims Addresses
ClaimsXTen FAQs
Tips for Claims/Encounters Filing
NIA Claims Matrix
False Claims Policy
Utilization ManagementUtilization Management
eviCore
Precertification Reference List
Utilization Management Appeal Process for Administrative Denials
Well-Being Screening Tool
COVID-19
Stay informed.
Get the latest information on COVID-19.

Clinical Authorization Forms

Pdf ImagePrivate Duty Nursing - Initial Request Form  

Pdf ImagePrivate Duty Nursing - Reauthorization Request Form  

Pdf ImageCranial Remolding Helmet Form  

Pdf ImageMedical Day Care Authorization Process  

Pdf ImageMedical Day Care Authorization Form  

Pdf ImagePersonal Care Assistant (PCA) Authorization Request Form  

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