Not Elsewhere. Dental Provider Resources Your online dental claims, eligibility and benefits website has changed! Premium includes a $1 administrative fee. Services and products may be provided through Horizon Blue Cross Blue Shield of New Jersey, Horizon Healthcare of New Jersey, Inc., Horizon Healthcare Dental, Inc., Horizon Casualty Services, Inc., or Horizon NJ Health*, a product of Horizon HMO, each of which is an independent licensee of the Blue Cross and Blue Shield Association. To see all available Qualified Health Plan options, go to the Health Insurance Marketplace website at There are more advantages. The plan covers frequently needed, eligible preventive and diagnostic services and selected eligible basic services at 100 percent when members use dentists participating in the Horizon PPO Network. Update: Members Will Incur No Costs for Treatment of COVID-19 through 2020Update: Cost-share waiver for telemedicine and COVID-19 testing extendedDates for Certain Prior Authorization Waivers Further ExtendedUse Modifier CS to Identify Services Subject to Cost Share WaiverNew Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769COVID-19 Update: Medical Policy Revisions & Implementations72 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 HorizonA special message from Howard A. Cutler, Vice President, Healthcare DeliveryBehavioral Health Continuity During the COVID-19 Public Health EmergencyWaiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility AdmissionsHorizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health ProfessionalsCOVID-19 Update: Authorizations Waived for Oxygen Following ER DischargeReminder to use specific codes when evaluating for COVID-19COVID-19 Update: Telemedicine Reimbursement Policy AddendaProvisionally Join Horizon BCBSNJ Network(s) to Assist with the COVID-19 PandemicWaiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissionsCOVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine ServicesEliminating Cost Sharing Related to COVID-19 Testing and EvaluationJoin 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)Specialty Pharmaceuticals for Office AdministrationRemote Patient Monitoring for COPD Provided by HGE HealthReferral Process Using the Interactive Voice Response SystemEffective use of the Interactive Voice Response SystemAbout the Surgical and Implantable Device Management ProgramUsing Out-of-Network Providers in Surgical ServicesAppeals of Non-Utilization Management DeterminationsAppeals of Utilization Management/Medical Management DeterminationsAppeals of Post Service Medical Necessity DeterminationsAppointment Availability Access Standards for Primary Care-Type Providers, ObGyns and SpecialistsCredentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) ProvidersCredentialing and Recredentialing Policy for Participating Physicians and Healthcare ProfessionalsOutlier Audit Programs: Post Payment and Pre-PaymentPhysician and Healthcare Professional Counseling and Termination Policy - Professional CompetencyParticipation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon NetworkPractitioner Office Site Quality and Medical Record Keeping StandardsContinuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) SuppliesDaily Management of Epidural or Subarachnoid Continuous Drug AdministrationDaily Maximum Units for Surgical Pathology and Microscopic ExaminationDistinct Procedural Service Modifiers (59, XE, XP, XS, XU)Duplicate Claim Logic for Independent Laboratory ServicesEvaluation and Management Services with Chiropractic Manipulative TreatmentEvaluation and Management Services with Osteopathic Manipulative TreatmentEvaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion ImagingFrequency of Care Coordination Services and ESRD ProceduresMutually and Non-Mutually Exclusive NCCI Supplemental EditsOutpatient Laboratory Claims: Referring Practitioner RequiredPulmonary Diagnostic Procedures when billed with E&M CodesReimbursement and Billing Guidelines for Anesthesia ClaimsRemoval of Impacted Cerumen Requiring InstrumentationScreening and Diagnostic Mammography & 3D TomosynthesisTelemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and productsTelemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare AdvantageUrinalysis with Evaluation and Management (E&M) ServicesPT/OT Outpatient Prior Authorization for Horizon Medicare Advantage PlansPrior 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)Participating Physician and Other Health Care Professional Office Manual

Services and products may be provided through Horizon Blue Cross Blue Shield of New Jersey, Horizon Healthcare of New Jersey, Inc., Horizon Healthcare Dental, Inc., Horizon Casualty Services, Inc., or Horizon NJ Health*, a product of Horizon HMO, each of which is an independent licensee of the Blue Cross and Blue Shield Association. A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. •Claims paid on a fixed fee schedule basis •25% - 35% average discount Horizon Dental Choice (DHMO) 324 Horizon Individual Dental (Horizon Dental Choice Plan I) •Managed Care network •Approximately 324 providers participate •Claims paid on a capitation/fee for service basis •New Jersey network only This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not the Health Insurance Marketplace website. The Horizon Dental Companion Plan is similar to the Horizon Dental PPO Access Plan, but sold only to groups that have Horizon BCBSNJ medical coverage. They provide members with a list of participating dentists to choose from. Classified … CommCare. The dentists on this list have agreed to a lower fee schedule, which provides you with greater cost savings. ZJan 1, 2016 … This plan, UnitedHealthcare® Group Medicare Advantage (PPO), ….

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