Horizon NJ Health has several departments that provide services to our members. Each department performs an important role in helping you provide the highest level of care and professional help to our membership.

Professional Contracting & Servicing

A Provider Contracting & Strategy Department representative is available to visit your office and/or facility to provide orientation and training on Horizon NJ Health policies and administrative procedures.

Please send documentation to us regarding changes in your practice, such as:

• Office relocation address
• Changing the name of your practice
• Changing your phone number
• Changing your fax number
• Changing your tax ID number
• Adding or removing a physician to or from your practice
• Changing your hospital affiliation
• Receiving new or updated documents related to your credentialing or recredentialing process
• Changing the open or closed status of your panel (this applies to PCPs only and has a 90 day waiting period)
• Requesting in-service/orientation for yourself, staff or facility
• Changing your address, including your billing address

Please mail or email your notification to our Provider Contracting & Strategy Department at:

Horizon BCBSNJ
3 Penn Plaza East
Mail Station PP-14C
Newark, NJ 07105
Email: EnterprisePDM@HorizonBlue.com

To assist you with the provider update process, a reference guide to the required documentation is noted.

This information can also be found on our Demographic Updates page.

MLTSS Provider Services

MLTSS Provider Services is available to provide general information about policies, administrative procedures, eligibility, member benefits, member care, billing, claims and capitation inquiries, coordination of benefits and other services available for members.

MLTSS Provider Services is available at 1-855-777-0123, 24 hours a day, seven days a week.

Translation services are available by calling 1-800-682-9094 x89469.

MLTSS Member Services

Horizon NJ Health cares about making sure our members in the MLTSS program have the information they need to make informed decisions and have someone they can speak to if they have any issues or questions. Member Services is available to MLTSS members 24 hours a day, seven days a week. Member Services will:

• Internally represent the interests of MLTSS members and assist them in understanding the MLTSS Services versus plan benefit
• Provide education to members, families and providers on issues related to the MLTSS program
• Assist members in navigating our system
• Be a resource for members by providing information, making referrals to other staff members and resolving issues

Utilization Management Department

The Utilization Management (UM) Department coordinates hospital admissions, precertification, discharge planning and home care services. This department also assists physicians in managing the services provided to members.

Horizon NJ Health’s UM program oversees the prompt, efficient delivery of quality health care services and evaluates the appropriateness of medical resources utilized by our members.

Prior authorization, concurrent review, discharge planners and care managers are available to coordinate care for members with complex medical and/or social problems, as well as to educate members about covered services and the utilization management process.

Utilization Management Department
1-800-682-9094
Monday through Friday, 8 a.m. to 5 p.m., Eastern Time (ET)
Saturday and Sunday, 9 a.m. to 5 p.m. ET

Or

Provider Services
1-800-682-9091
Monday through Friday, 8 a.m. to 5 p.m. ET
To speak to a member’s Care Manager, call 1-844-444-4410.

UM Ethical Standards

Horizon NJ Health adheres to the following principles in the conduct of the UM program:

• UM decisions made are based solely on the necessity and appropriateness of care and service within the parameter of the member’s Medicaid benefit.
• Horizon NJ Health does not compensate those responsible for making UM decisions in a manner that provides incentive to deny or approve coverage for medically necessary and appropriate covered services.
• Horizon NJ Health does not offer its employees performing UM review incentives to encourage denials of coverage or service that are medically necessary and does not provide financial incentives to hospitals, physicians and other health care professionals to withhold covered health care services that are medically necessary and appropriate.