Medical Transition Care Benefit Request Form - Horizon Blue Cross 2025

Show details

4.8 out of 5

40 votes

The document is a Medical Transition Care Benefit Request Form from Horizon Blue Cross Blue Shield of New Jersey. It outlines the process for new subscribers to request continued medical care from non-participating providers at in-network benefit levels for acute injuries or illnesses. The form requires information from both the patient and their treating physician, including diagnosis, treatment plans, and authorization for information sharing. It also details the eligibility criteria for transition care, examples of conditions that qualify or do not qualify, and the review process for submitted requests.

Here's how it works

01. Edit your horizon transition online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

The best way to edit Medical Transition Care Benefit Request Form - Horizon Blue Cross in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Adjusting documents with our extensive and intuitive PDF editor is straightforward. Make the steps below to complete Medical Transition Care Benefit Request Form - Horizon Blue Cross online quickly and easily:

Sign in to your account. Log in with your email and password or register a free account to try the service before upgrading the subscription.
Upload a form. Drag and drop the file from your device or import it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit Medical Transition Care Benefit Request Form - Horizon Blue Cross. Quickly add and underline text, insert pictures, checkmarks, and icons, drop new fillable areas, and rearrange or delete pages from your document.
Get the Medical Transition Care Benefit Request Form - Horizon Blue Cross accomplished. Download your modified document, export it to the cloud, print it from the editor, or share it with other people using a Shareable link or as an email attachment.

Benefit from DocHub, the most straightforward editor to promptly handle your paperwork online!

See more Medical Transition Care Benefit Request Form - Horizon Blue Cross versions

We've got more versions of the Medical Transition Care Benefit Request Form - Horizon Blue Cross form. Select the right Medical Transition Care Benefit Request Form - Horizon Blue Cross version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2022	4.8 Satisfied (55 Votes)
2020	4.4 Satisfied (134 Votes)
2020	4.7 Satisfied (51 Votes)
2020	4.3 Satisfied (26 Votes)
2020	4.2 Satisfied (36 Votes)
2020	4.8 Satisfied (101 Votes)
2020	4.8 Satisfied (261 Votes)
2020	4.8 Satisfied (117 Votes)
2020	4.8 Satisfied (247 Votes)
2019	4.8 Satisfied (130 Votes)
2019	4.8 Satisfied (54 Votes)
2019	4.8 Satisfied (51 Votes)
2019	4.8 Satisfied (142 Votes)
2019	4.8 Satisfied (35 Votes)
2019	4.8 Satisfied (171 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can I sign my [KEY] on a mobile?

Sure, you’ll find many different applications for this on the web. However, if you need to eSign your [KEY] without installing additional software, DocHub is the best choice you can make. This powerful editor works on mobile devices just like on desktops. Open our editor in any internet browser, register or log in to your account, and start managing your paperwork.

How do you fill out [KEY] on iOS?

You need only a web connection and a web browser to complete your [KEY] by using an iOS phone. Open the DocHub website and authenticate. Then, add your file or select it from the list in your dashboard. Then use our editing instruments to complete your form and preserve all your changes. You can also send it to a dedicated recipient right away.

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

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.

Medical Transition Care Benefit Request Form - Horizon Blue Cross 2025

Here's how it works

The best way to edit Medical Transition Care Benefit Request Form - Horizon Blue Cross in PDF format online