This policy applies to demographic information pertaining to newly contracted or credentialed physicians, other healthcare professionals, facilities and ancillary providers as well as changes to the demographic information pertaining to existing participating physicians, other healthcare professionals, facilities and ancillary providers. CMS QHP Network Adequacy 45 CFR 156.230 Inaccurate and/or missing information identified is corrected in the provider files location/system and downloaded to our Doctor & Hospital Finder for update as outlined in the section, Procedure for Creating a New Provider Directory File of this document. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and … If you have questions about any of the above, please see the first and last cover pages of this directory for information on how to contact Horizon Blue Cross Blue Shield of New Jersey. Power 2020 award information, visit jdpower.com/awards. Once changes are completed and reviewed for accuracy, the appropriate files department saves the updates made. Provider Data Management Outreach and Audit Program Directory Requirements Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its … Billing for Horizon Blue Cross Blue Shield of New Jersey Home Health Providers Overview General Billing Tips. Provider Directory Management. Power 2020 award information, visit jdpower.com/awards. Review information about the Horizon Behavioral Health program. These are just a … Visit Blue365. This policy applies to processes that ensure that accurate participating provider network information is made available to members enrolled in all of the plans and products we offer, including QHP plans and products, in a reasonable timeframe through our online Doctor & Hospital Finder and our printed provider directories. Products and services are provided by Horizon Blue Cross Blue Shield of New Jersey, Horizon Insurance Company, Horizon Healthcare of New Jersey, Braven Health, and/or Horizon Healthcare Dental, Inc., each an independent licensee of the Blue Cross and Blue Shield Association. For J.D. Procedure for Creating a New Provider Directory File, Procedure for Existing Hospital/ Ancillary/ Professional Provider Directory Maintenance, Procedure to Ensure Accuracy of Provider Directories, Procedure to Ensure Accuracy of Medicare Advantage Provider Directories. New Jersey's phased approach to administer COVID-19 vaccines to those who live, work or study in the state is now underway. The vendor will create print on demand directories upon request from members, prospective members, network providers and/or internal departments. Please click Continue to leave this website in order to access the Plan Comparison Tool where you can compare medical plan costs. Practitioners may be terminated from participation if validation is not received within 180 days after suppression. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Purpose: Or, if you would like to remain in the current site, click Cancel. If Horizon BCBSNJ receives feedback regarding the content of our Doctor & Hospital Finder, we will research and update our files as needed. Provider Directory Providers are added to the network on an ongoing basis or may discontinue their participation in the network. Please click Continue to leave this website in order to access the Plan Comparison Tool where you can compare medical plan costs. Products and services are provided by Horizon Blue Cross Blue Shield of New Jersey, Horizon Insurance Company, Horizon Healthcare of New Jersey, Braven Health, and/or Horizon Healthcare Dental, Inc., each an independent licensee of the Blue Cross and Blue Shield Association. Please note, on the next page, only the information in the yellow box applies to DSM employees -- complete the information required. Or, click Cancel to remain on the current site. ® SM Registered and Service Marks of the Blue Cross and Blue Shield Association. Please contact the healthcare … 02, 2020 | 08:37 AM America/New_York. We’re always here for you and your patients. Scope: The physician data elements that are verified are: The online Doctor & Hospital Finder and on demand hardcopy provider directories are updated no greater than every 30 days. Answers and care made simple The Horizon Blue app offers easy access to your insurance information, including benefits, coverage details and status of your claims. Member Discounts Take advantage of member-only discounts on health-related products and services. Commercial HMO & POS, COVID-19 vaccines available in Essex County – Information for your staff and patients, Reimbursement Policy effective January 1, 2021: Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005), Update: Members’ cost sharing waived for treatment of COVID-19 through March 2021, COVID-19 vaccines will be covered at 100%, Waiving Prior Authorization Requirements for Emergent In-Network Inpatient Admissions and Post-Acute Facility Admissions, Update: Cost-share waiver for telemedicine and COVID-19 testing extended, Cost Sharing on Claims with Multiple Diagnoses, Dates for Certain Prior Authorization Waivers Further Extended, Dates for Prior Authorization Waivers Extended, New Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769, COVID-19 Update: Medical Policy Revisions & Implementations, 72 Doctors, Nurses, Pharmacists and Health Clinicians from Horizon BCBSNJ Answer Governor Murphy’s “HealthCare Professionals Call to Serve”, New Jersey Pandemic Relief Fund Efforts Get $2 Million Boost from Horizon, A special message from Howard A. Cutler, Vice President, Healthcare Delivery, Behavioral Health Continuity During the COVID-19 Public Health Emergency, Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility Admissions, Horizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health Professionals, COVID-19 Update: Authorizations Waived for Oxygen Following ER Discharge, Reminder to use specific codes when evaluating for COVID-19, COVID-19 Update: Telemedicine Reimbursement Policy Addenda, Provisionally Join Horizon BCBSNJ Network(s) to Assist with the COVID-19 Pandemic, Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions, Providing Telephonic care with no costs to members, COVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine Services, Eliminating Cost Sharing Related to COVID-19 Testing and Evaluation, Join a Horizon BCBSNJ or Horizon NJ Health Network (Physicians and Other Healthcare Professionals ), Join the Horizon BCBSNJ Network (Ancillary Providers), Join the Horizon NJ Health Network (Ancillary Providers), BlueCard Medical Policy/Pre-Certification Info, Braven Health℠ Electronic Data Interchange (EDI), Horizon BCBSNJ Electronic Data Interchange (EDI), Prior Authorization/Pre-Service Registration, Specialty Pharmaceuticals for Office Administration, Medicare Advantage Network Plans Overview, Braven Health℠ Plans(Medicare Advantage), New Jersey Infection Prevention Partnership, Remote Patient Monitoring for COPD Provided by HGE Health, Referral Process Using the Interactive Voice Response System, Effective use of the Interactive Voice Response System, Surgical and Implantable Device Management Program, About the Surgical and Implantable Device Management Program, Surgical and Implantable Device Management Program for Cardiac Surgeries Frequently Asked Questions Updated: October 6, 2020, Surgical and Implantable Device Management Program Orthopedic Services Frequently Asked Questions Updated: October 6, 2020, Using Out-of-Network Providers in Surgical Services, CMS Audits to Validate Directory Information, Time Limits for Filing Inquiries/Complaints, Appeals of Non-Utilization Management Determinations, Appeals of Utilization Management/Medical Management Determinations, Appeals of Post Service Medical Necessity Determinations, Allowable Practice Locations for Pathologists, Appointment Availability Access Standards for Primary Care-Type Providers, ObGyns, Specialists and Behavioral Health Providers, Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers, Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals, EDI and NaviNet Claims Submission Requirement, Material Adverse Change (MAC) Notification Policy, Outlier Audit Programs: Post Payment and Pre-Payment, Physician and Healthcare Professional Counseling and Termination Policy - Professional Competency, Participation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon Network, Practitioner Office Site Quality and Medical Record Keeping Standards, Standards for All Types of Medical and Dental Diagnostic Radiology and Imaging Facilities, Use of Horizon Hospital Network Performance Data, Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005), Ambulatory Electrocardiographic Monitoring, Bariatric Surgery Billed With Hiatal Hernia Repair, Billing Guidelines for Maternity Services, Cardiovascular Implant Device Monitoring Services, Claims Requiring Additional Documentation, Continuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) Supplies, Daily Management of Epidural or Subarachnoid Continuous Drug Administration, Daily Maximum Units for Surgical Pathology and Microscopic Examination, Distinct Procedural Service Modifiers (59, XE, XP, XS, XU), Duplicate Claim Logic for Independent Laboratory Services, Evaluation and Management Services with Chiropractic Manipulative Treatment, Evaluation and Management Services with Osteopathic Manipulative Treatment, Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion Imaging, Frequency of Care Coordination Services and ESRD Procedures, Hospital Non-Patient Laboratory Services Sample Fees, Laser Treatment of Psoriasis or Parapsoriasis, Mutually and Non-Mutually Exclusive NCCI Supplemental Edits, Outpatient Laboratory Claims: Referring Practitioner Required, Physician Extenders Non-Surgical Services, Pre-Payment Documentation Requests: Facility Claims, Post Payment Documentation Requests: Facility Claims, Pulmonary Diagnostic Procedures when billed with E&M Codes, Reimbursement and Billing Guidelines for Anesthesia Claims, Removal of Impacted Cerumen Requiring Instrumentation, Screening and Diagnostic Mammography & 3D Tomosynthesis, Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and products, Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare Advantage, Urinalysis with Evaluation and Management (E&M) Services, PT/OT Outpatient Prior Authorization for Horizon Medicare Advantage Plans, Prior Authorization Procedure Search Tool, Prior Authorization Requirements for UHH Group #76141(Atlantic City), Prior Authorization Requirements for UHH Group 76215 76315 (New York), Prior Authorization Requirements for UHH Group #s76275 & 76307 (Food Service Plan 376), and UHH Group #s 76305 & 76306 (Food Service Plan 176), Policies, Procedures and General Guidelines, Programs Administered by eviCore healthcare, Participating Physician and Other Health Care Professional Office Manual, Radiation Therapy Medical Necessity Determination, Radiology Professional Group Assessment Tool, Availability of Printed Directories and Web Based Provider Directory Information Through Alternate Media, Requests to Change Provider Directory Content via Electronic Media, Claims Payment Policies and Other Information. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. Commercial PPO/EPO & … Upon receipt of the request, the appropriate department validates or makes the requested changes to the Hospital/Ancillary/Professional record in the appropriate provider files location/system within 20 days of receipt of request. Dec 2012 – Present 7 years 8 months. The Blue Cross Blue Shield System is made up of 36 independent and locally operated companies. Products and services are provided by Horizon Blue Cross Blue Shield of New Jersey, Horizon Insurance Company, Horizon Healthcare of New Jersey, Braven Health, and/or Horizon Healthcare Dental, Inc., each an independent licensee of the Blue Cross and Blue Shield Association. Provider demographic information will be sent to the contracted vendor on a monthly basis or more frequently as required. The Credentialing Department creates a file within the appropriate internal system containing the demographic information pertaining to that Hospital/Ancillary/Professional. If you need help, we’ve created these helpful guides: Step-by-Step PDF; Search as Guest × Footer Skip to footer content. Need a form? Horizon Blue Cross Blue Shield NJ Doctor & Hospital Finder - Online provider directory for best doctors, dentists, hospitals and PCPs by your location, specialty near you. Connect with us ‌ ‌ ‌ ‌ ‌ Products are provided by Horizon NJ Health. New Hospital/Ancillary/Professional information is displayed within the Doctor & Hospital Finder within 24 to 48 hours. 25 miles for specialists and ancillary providers. Marketplace Transparency You can also chat with a nurse or see a doctor virtually directly on your mobile device. This policy also helps ensure that the contents of the directories are fully compliant with all regulatory and accrediting requirements. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and … Learn more about Braven Health and your participation status. The physician record attestation date is equivalent to the outreach date. The anticipated date on which the next printed edition will be published. The carrier’s website address where the electronic directory can be accessed. Horizon BCBSNJ accepts directory maintenance files to update demographic information and participation status of practitioners. You have until January 31, 2021 to apply for Individual health care coverage effective February 1, 2021. Members are notified annually of the availability of the information in our Doctor & Hospital Finder and are provided with a reply card to request a printed directory. To access your member services, please visit your BCBS company. Quarterly Claim Editing Update: First Quarter 2021, Announcing the TurningPoint Safety and Quality Award Program for Orthopedic Specialists. To see all available Qualified Health Plan options, go to the New Jersey Health Insurance Marketplace at Get Covered NJ. Horizon Blue Cross Blue Shield of NJ. Find my BCBS company . Or, click Cancel to remain on the current site. Horizon BCBSNJ conducts a monthly audit on updated records. Leadership Perspectives. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. You are now leaving Horizon Blue Cross Blue Shield's website for DSM employees. Requests may be initiated via our online Demographic Update tool, by completing and submitting a copy of our File Change Request Form, or by submitting a letter on the practice’s or facilities letterhead. Please click Continue to leave this website in order to access the Plan Comparison Tool where you can compare medical plan costs. This policy documents the processes and procedures we have in place to ensure that accurate participating provider network data is made available to members enrolled in the plans we offer through the Doctor & Hospital Finder and printed provider directories. For J.D. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. 877-860-2837 (Blue Cross Community Health Plans) 877-723-7702 (Blue Cross Community MMAI) 877-774-8592 (Blue Cross Medicare Advantage) 800-676-2583 (Eligiblity - Out of State BCBS) 800-972-8382 (Eligibility - FEP) Indiana: 888-802-2160 855-251-8827 (Health Maintenance Organization) 855-558-1438 (L Preferred Provider Organization) Horizon BCBSNJ will maintain a history of the electronic directories for three years. On a quarterly basis, a Network Outreach Specialist will call practice locations to validate practice’s information. The Hospital/Ancillary/Professional information submitted is reviewed by our Credentialing Committee and a determination is made to accept or deny the request for participation. COVID19. Languages spoken at the office other than English. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. Back. All are independent licensees of the Blue Cross and Blue Shield Association. Please click Continue to leave this website. This requirement may be met by establishing a capability of reconstructing a directory as of any date within the prior three years. Online Provider Directory Features (OLI Document) Products and services are provided by Horizon Blue Cross Blue Shield of New Jersey, Horizon Insurance Company, Horizon Healthcare of New Jersey, Braven Health, and/or Horizon Healthcare Dental, Inc., each an independent licensee of the Blue Cross and Blue Shield Association. Please call Member Services toll free at 1-800-682-9090 Call: 1-800-682-9090 (TTY/TDD 711) to request a copy. The Blue Cross Blue Shield System is made up of 36 independent and locally operated companies. The Doctor & Hospital Finder and printed directories will contain the following fields for each provider as required by CMS, DOBI and NCQA: The electronic directories will be published in a JavaScript Object Notation (JSON) Format, also known as a machine readable format. The Benefit of Blue℠ is a service mark of the Blue Cross Blue Shield Association. Horizon BCBSNJ will provide print on demand directories upon request. Horizon BCBSNJ will not display any practitioner information within our Online Doctor & Hospital Finder that are unable to be validated. Category. Requests to Change Provider Directory Content via Electronic Media You know what it takes to keep … If after the third attempt Horizon in unsuccessful to validate the information the practice will be suppressed from our Online Doctor & Hospital Finder. The Blue Cross® and Blue Shield® names and symbols are … Hospital quality data from a recognized source. How do I get a provider directory? Or, if you would like to remain in the current site, click Cancel. Following the Credentialing Committee approval of a particular Hospital/Ancillary/Professional, the provider files are updated to reflect a participating status. The appropriate Contracting/Credentialing Department ensures that all required information is received to allow the contracting/credentialing team to conduct a complete review of the submitted information. 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