Utilization Management

Utilization Management Request Tool
Use our online Utilization Management Request Tool, available 24/7, to easily and securely submit authorization and referral requests to us for your Horizon NJ Health and Horizon NJ TotalCare (HMO D-SNP) patients. The Utilization Management Request Tool can also be used to check the status of your requests. To access this tool, simply sign in to NaviNet and from the Horizon NJ Health plan central page, select Utilization Management Requests.

Prior Authorization Procedure Search Tool
Use our Prior Authorization Procedure Search Tool, available 24/7, to determine if you need to get prior authorization (PA) before providing services to your Horizon NJ Health and Horizon NJ TotalCare (HMO D-SNP) patients.

We collaborate with certain business partners to manage PA reviews on our behalf. The tool will let you know when requests need to be submitted directly to these business partners.