eviCore will provide Utilization Management programs for Radiation Therapy and Radiology/Cardiology for Horizon NJ Health and Horizon NJ Total Care (HMO D-SNP) members effective January 1, 2020. However, eviCore will begin accepting authorization requests on December 16, 2019 for dates of service beginning January 1, 2020. Horizon BCBSNJ is partnered with eviCore healthcare to manage Advanced Imaging Services for our members through Prior Authorizations/Medical Necessity Determinations (PA/MND) with physicians. eviCore healthcare helps to ensure our members receive appropriate radiology/imaging services, provides clinical consultation to our participating healthcare professionals and assists in the scheduling of radiology/imaging services. The Advanced Imaging Services included in this program are CT/CTA, MRI/MRA, PET and Nuclear Medicine studies (including Nuclear Cardiology).

Please note that eligibility and participation may vary based on line of business therefore, all providers should check eligibility and benefits prior to performing any services related to this program. In addition, actual benefit determinations cannot be made until a claim is received and is subject to the provisions of the patient’s present contract including any applicable deductible, coinsurance and/or coordination of benefits.

Prior authorization through eviCore does not apply to services that are performed in:

• Emergency room
• Inpatient
• 24-hour observation

Prior authorization applies to services that are:

• Outpatient
• Elective / Non-emergent

Authorization is required for Horizon BCBSNJ members enrolled in the following programs:

• Medicaid Managed Care
• NJ FamilyCare
• Horizon NJ TotalCare (HMO D-SNP)
• Managed Long Term Services & Supports (MLTSS)

Providers and/or staff can request prior authorization in one of the following ways:

Web Portal

The eviCore portal is the quickest, most efficient way to request prior authorization and is available 24/7. Providers can request Authorization at eviCore.com.

Call Center

eviCore’s call center is open from 7 a.m. to 7 p.m. local time. Providers and/or staff can request prior authorization and make revisions to existing cases by calling 1-866-496-6200.

eviCore's call center will be closed in observance of New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving and the day after, and Christmas Day. The eviCore web portal is available 24 hours a day, seven days a week, 365 days a year.

Horizon NJ Health Pre-Authorization Codes Managed by eviCore