Digital Member ID Card Policy
Policy:
Digital Member ID Card Policy
Effective Date:
August 1, 2022
Purpose
Require providers to accept Digital Member ID Card as proof of coverage. Providers may not require that a member present a physical ID card as proof of coverage. This policy will also support the current procedure outlined in our Provider Adminstative Manual that providers must verify eligibility and coverage through NaviNet.
Scope
The guidelines of this policy apply to members enrolled in plans offered by Horizon NJ Health.
Policy
Providers are required to accept Horizon NJ Health Digital Member ID Cards. Providers may not refuse to provide services to a member if a traditional, physical Horizon NJ Health ID card is not presented. Digital Member ID Cards provide a secure way to access the most up-to-date member enrollment information when members present for care.
Providers must continue to verify eligibility through NaviNet.
Providers can also call 1-800-682-9091.
Horizon NJ Health members are able to access Horizon NJ Health Digital Member ID Card images by signing in to the Horizon NJ Health app from a smart device. Members can use the app to email or text a copy of their Horizon NJ Health Digital Member ID Card to a provider office.
Per the the Provider Administrative Manual, the Horizon NJ Health Digital Member ID Card cannot be accepted as the sole verification of a member's eligibility to receive benefits. To confirm eligibility, visit NaviNet.net or call 1-800-682-9091 at the time of service. (See Section 2.5 Determining Eligibility of the Provider Administrative Manual).
Definitions
Digital Member ID Card – An electronic ID card available through the Horizon NJ Health App. Digital Member ID Cards include the same detail and information that would be included on a traditional physical Horizon NJ Health ID card.
Sanctions
Providers that refuse to provide treatment to members who do not present a traditional physical Horizon NJ Health ID card will be addressed in a manner consistent with contractual rights and remedies, including, but not limited to, termination with cause from our network(s). Horizon NJ Health will continue to work with providers to provide education about Horizon NJ Health Digital Member ID Cards and help ensure that they have up-to-date information.
Exceptions
No exceptions are permitted.