MLTSS Provider Manual

Welcome to Horizon NJ Health

We are pleased you are a participating provider and part of Horizon NJ Health, a Medicaid managed care plan that administers a managed care program for Medicaid/NJ FamilyCare members and those enrolled in Supplemental Security Income (SSI), Division of Child Protection & Permanency (DCPP) and clients of the Division of Developmental Disabilities (DDD) in New Jersey.

As a network provider, you have an opportunity to build a mutually beneficial program for members enrolled in the Managed Long Term Services & Supports (MLTSS) program and for yourself. Horizon NJ Health is committed to supporting you, and we look forward to working with you to provide the best quality service possible to our members.

About This Document

The Non-Medical Professional Provider Administrative Manual is a guide to the policies and administrative procedures of our MLTSS program. Use this manual as a guide to answer questions about authorization policies, member benefits, claim submissions and many other issues. Your failure to comply with any policies, rules and procedures may constitute a breach of your Participating Provider Agreement.

This Manual also provides day-to-day operational details that can be helpful to you and your staff. The Manual will clarify and detail the requirements identified in your Agreement. Periodic updates to the Manual will be provided.

If you, or your staff, have any questions or concerns about the information in this manual, please call MLTSS Provider Services at 1-855-777-0123.