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Medical Transition Care Benefit Request Form - Horizon Blue Cross 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the Effective Date of Coverage and Policy Number at the top of the form. This information is crucial for processing your request.
- Fill in your Employer Name, Employee/Retiree Name, and Address details. Ensure all names are spelled correctly to avoid any delays.
- Provide your Member ID number and Retiree Date of Birth as indicated. This information helps verify your eligibility.
- If applicable, include Dependent Name and Address details along with their Date of Birth and Relationship to you.
- Indicate whether your current insurance company covers the requested services and if you have other health insurance.
- In the section for the treating physician, enter their name, contact information, diagnosis details, and treatment plan. This section must be completed by your physician.
- Finally, sign the authorization section to allow your physician to share necessary information with Horizon Blue Cross. Make sure to date your signature.
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See more horizon transition versions
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2023 | 4.4 Satisfied (32 Votes) | |
| 2023 | 4.2 Satisfied (49 Votes) | |
| 2022 | 4.8 Satisfied (55 Votes) | |
| 2020 | 4.8 Satisfied (247 Votes) | |
| 2020 | 4.8 Satisfied (101 Votes) | |
| 2020 | 4.4 Satisfied (134 Votes) | |
| 2020 | 4.8 Satisfied (261 Votes) | |
| 2020 | 4.8 Satisfied (117 Votes) | |
| 2020 | 4.3 Satisfied (26 Votes) | |
| 2020 | 4.7 Satisfied (51 Votes) | |
| 2020 | 4.2 Satisfied (36 Votes) | |
| 2020 | 4.1 Satisfied (59 Votes) | |
| 2020 | 4.5 Satisfied (39 Votes) | |
| 2019 | 4.8 Satisfied (130 Votes) | |
| 2019 | 4.8 Satisfied (79 Votes) |
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How do I submit a corrected claim to Horizon NJ Health?
Corrected Claims CMS-1500 should be submitted with the appropriate resubmission code (value of 7) in Box 22 of the paper claim with the original claim number of the corrected claim.
What is the phone number for Horizon BCBS of NJ prior authorization?
If you need to obtain prior authorization for a Horizon member, you can submit your request via the Utilization Management Request Tool on NaviNet or call 1-800-664-BLUE (2583).
What is the provider line for Horizon BCBS of New Jersey?
General Contacts Provider Services1-800-682-9091MLTSS Provider Services1-855-777-0123Member Services Someone is available 24 hours a day, seven days a week to help you1-800-682-9090 (TTY 711)NaviNet Customer CareNaviNet Customer Care opens a dialog window1-888-482-805717 more rows
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People also ask
What is the address for Horizon Healthcare of New Jersey refund?
Returning Provider Identified Overpayments For overpayments made on claims for:Mail overpayments to:Horizon NJ Health NJ FamilyCare or Horizon NJ TotalCare (HMO D-SNP) membersHorizon NJ Health Member/Provider Correspondence PO Box 24077 Newark, NJ 07101-04063 more rows
What is the mailing address for Horizon NJ direct claims?
Claims Services. PO Box 24077. Newark, NJ 07101-0406.
How do I submit a claim to Horizon BCBS of NJ?
Submit your claim with the Horizon Blue App in a few easy steps: 01 / Use your mobile device to take pictures of your itemized bill or receipts. 02 / Open the app and tap on the Claims section. 03 / Tap Submit A Claim.
What is the phone number for Horizon BCBSNJ Direct Provider?
How to locate a Horizon Direct Access provider. Members can locate Horizon Direct Access network providers with the Doctor Hospital Finder or they can also call Member Services at 1-800-355-BLUE (2583) to access participating providers.
What is the mailing address for Horizon BCBS of New Jersey?
Use our Email Us tool. Under Category, choose Enrollment; or. Send a written request to: Horizon, PO Box 10138, Newark, NJ 07101.
Related links
To request continued coverage, contact the Office of Client Services at (609) 292-7524or write to the Division of Pensions Benefits, Health Benefits Bureau,
The College offers a variety of medical health benefit plans through Horizon Blue Cross Blue Shield of New Jersey and Aetna under the New Jersey EducatorsRead more