Provider Contacts
General ContactsGeneral Contacts
| Provider Services | 1-800-682-9091 |
| Behavioral Health: For children younger than 18 years of age | Children requiring Care Management assistance for behavioral problems or mental health issues should be directed to the State of New Jersey's Children's System of Care Program at 1-877-652-7624. Staff is available 24 hours a day, seven days a week. DDD, MLTSS and FIDE-SNP members can call our Member Services for assistance. |
| Behavioral Health: For adults 18 years and older | The NJ Mental Health Cares Program, New Jersey's mental health information and referral service, is available during normal business hours at 1-866-202-4357. Hotline staff will refer members to community mental health programs throughout the State of New Jersey. DDD, MLTSS and FIDE-SNP members can call our Member Services for assistance. Members not enrolled with DDD, MLTSS or FIDE-SNP should call their local Medical Assistance Customer Center (MACC) for mental health services. To find the number of a local MACC, call the NJ FamilyCare hotline toll free at 1-800-701-0710 (TTY 711). |
| Behavioral Health: After Hours | Member may call the State of New Jersey's 211 program toll free at 1-877-652-1148 (TTY 711), 24 hours a day, seven days a week. |
| 1-800-682-9094 x89385 Type of Calls
Division of Child Protection and Permanency (DCPP): 1-800-682-9094 x89907 Care/Case and Disease Management: 1-800-682-9094 x89634 Type of Member
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| Consent for Sterilization | A Family Planning Prior Authorization Request form and a HHS-687 Consent for Sterilization Form must be completed and signed by the member in advance of a sterilization procedures being performed. We require that all Consent for Sterilization Forms be submitted to its Health Services Department by faxing the form to 1-609-583-3047 at least 30 days in advance of the procedure. |
| Davis Vision | 1-800-933-9371 |
| Discharge Planning | 1-800-682-9094 x89347; Fax: 1-609-583-3029 |
| eviCore | 1-866-496-6200 |
| Horizon NJ Health Care/Case Manager To speak with a Care/Case Manager or learn about a Disease Management Program | 1-800-682-9094 (TTY 711) |
| Horizon NJ Health Enrollment Hotline For information on enrollment | 1-800-637-2997 |
| LabCorp | 1-800-631-5250 |
| ModivCare (Transportation) | 1-866-527-9933 (TTY 1-866-288-3133) |
| Managed Long Term Services & Supports (MLTSS) Member Services | 1-844-444-4410 (TTY 711) |
| MLTSS Claim Inquiries | Email: MLTSS_Provider@HorizonBlue.com |
| MLTSS Provider Services | 1-855-777-0123 |
| Member Services Someone is available 24 hours a day, seven days a week to help you | 1-800-682-9090 (TTY 711) |
| Availity Essentials™ | 1-800-AVAILITY (282-4548) |
| New Jersey State Health Benefits Coordinator (HBC) For questions about the status of your application | 1-800-701-0710 (TTY 1-800-701-0720) |
| Pharmacy Department | 1-800-682-9094 |
| SKYGEN USA Dental Provider Services | 1-855-878-5368 |
Network Relations AssignmentsNetwork Relations Assignments
MEDICAL PROFESSIONAL PRACTITIONERS/PRACTICES
| Network Specialist | County Assignment |
| Carol Brush 1-609-537-2574 | Gloucester Mercer |
| Jill Clark 1-973-466-4831 | Essex Hudson |
| Loveann Cranshaw 1-856-638-3117 | Atlantic Cape May Cumberland |
| Mark Gray 1-973-466-8020 | Bergen Morris |
| Maureen Hanson 1-609-537-2152 | Middlesex Union |
| Kathleen Hollinghurst 1-973-466-7781 | Hunterdon Monmouth Somerset |
| Janet Simeone 1-609-537-2373 | Camden Passaic Salem |
| Wanda Williams 1-973-466-7714 | Burlington |
| Stephanie Woodson 1-609-537-2313 | Ocean Sussex Warren |
BEHAVIORAL HEALTH PROFESSIONAL PRACTITIONERS/PRACTICES
| Network Specialists | County Assignment |
| Stephanie Bush 1-856-638-3606 – HBCBSNJ Phone 1-856-638-3609 – HNJH Phone Stephanie_Bush@HorizonBlue.com | Atlantic Cape May Gloucester (covering) Ocean |
| Michelle McCusker 1-856-638-3213 – HBCBSNJ Phone 1-856-638-3223 – HNJH Phone Michelle_McCusker@HorizonBlue.com | Camden Cumberland (covering) Middlesex Salem |
| Olivia Inniss 1-973-466-4584 – HBCBSNJ Phone 1-973-466-4609 – HNJH Phone Olivia_Inniss@HorizonBlue.com | Bergen Essex |
| Bryon Russell 1-973-466-4314 – HBCBSNJ Phone 1-856-638-3341 – HNJH Phone Bryon_Russell@horizonblue.com | Burlington Hudson Mercer (covering) Union |
| Kaitlyn Lehman 1-973-466-7733 – HBCBSNJ Phone 1-973-466-7561 – HNJH Phone Kaitlyn_Lehman@HorizonBlue.com | Hunterdon Morris Sussex (covering) Warren (covering) |
| Amanda Castillo 1-973-466-7753 – HBCBSNJ Phone 1-973-466-7559 – HNJH Phone Amanda_Castillo2@HorizonBlue.com | Monmouth Passaic Somerset |
MEDICAL ANCILLARY PROVIDERS/FACILITIES
| Provider Contracting Contact | Specialties | |
|---|---|---|
| Alana McDonald 1-609-537-2438 Alana_McDonald@horizonblue.com | Adult Medical Day Care/ Pediatric Medical Day Care Caregiver Participant Training* Chore Service (Cleaning/Maintenance)* Cognitive Therapy* Community Residential Services* Community Transition Services* Home Delivered Meals* Medication Dispensing* Non-Medical Transportation* Personal Emergency Response System (PERS)* Residential/Vehicle Modification* Social Adult Day* Traumatic Brain Injury (TBI)* | |
| Lori Bembry 1-609-537-2427 Lori_Bembry@horizonblue.com | Home Health Home-Based Supportive Care* Personal Care Assistant (PCA) Respite (In-Home)* Private Duty Nursing Hospice Home Infusion Sleep Studies Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| Denice Berrios 1-609-537-2446 Denice_Berrios@horizonblue.com | Assisted Living Program* Assisted Living Residence* Comprehensive Personal Care Home* Skilled Nursing Facility* Sub Acute Rehab | |
| Walgena Daniels 1-609-537-2335 Walgena_Daniels@horizonblue.com | Dialysis Orthotic & Prosthetic (O&P) Durable Medical Equipment (DME) Ambulance | |
| Crystal Coffee 1-973-622-7209 Crystal_Coffee@horizonblue.com | Ambulatory Surgery Centers Laboratory | |
* Denotes MLTSS Services
BEHAVIORAL HEALTH ANCILLARY PROVIDERS/FACILITIES
| Ancillary Contracting Specialists | County |
| Andrew Alleman 1-973-466-6824 Andrew_Alleman@HorizonBlue.com | Bergen Cumberland Essex Hudson Monmouth Morris Passaic Somerset Sussex Union Warren |
| Ashley Solis-Sotomayor 1-973-466-5814 Ashley_Sotomayor@HorizonBlue.com | Atlantic Burlington Camden Cape May Gloucester Hunterdon Mercer Middlesex Ocean Salem |
Claims and AppealsClaims and Appeals
| Claims | Claims and other billing forms should be submitted to:
|
| Dental Claims Inquiries | Dental claims should be submitted to:
|
| Utilization Management Appeals | Utilization Management decisions appeals should be submitted to:
Or Fax to 1-609-583-3028 You can also request an appeal by calling the UM Appeals Department at |
| Administrative Claim Appeals | Administrative Claim Appeals should be submitted to:
Or Fax to 1-973-522-4678 |
For questions regarding billing or appeals, please contact the Physician and Health Care Hotline at 1-800-682-9091 and/or your Professional Relations Representative.
Changes to Your PracticeChanges to Your Practice
We are required to maintain accurate information in our provider database. This information is essential for providing access to services for our members.
It is your responsibility to notify us prior to any change in the status of the practice or provider. This includes the sale or purchase of a practice, the addition of a provider or the retirement of a provider. In the case of a provider death, the practice should notify Horizon NJ Health immediately.
How to update your demographic information.
If you are terminating from the network, you must send a notice via certified mail, as per your agreement. Please send notification via certified mail with return receipt to:
Horizon NJ Health
1700 American Blvd
Pennington, NJ 08534
Attention: Network Relations
If you have any questions about this requirement, please contact your Network Specialist or Ancillary Contract Specialist.
AuthorizationsAuthorizations
| Service | Contact | Authorization Type |
| Inpatient | 1-800-682-9094 x81024 |
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| Outpatient Facility Office Based | 1-800-682-9094 x81023 |
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| Home Services | 1-800-682-9094 x81025 |
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| Medical Day Care | 1-800-682-9094 x81364 Fax: 1-609-583-3048 |
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| Personal Care Assistance | 1-800-682-9094 x81364 Fax: 1-609-583-3048 | |
| Durable Medical Equipment & Medical Supplies | 1-800-682-9094 x81017 |
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| Facility PT/OT/ST | 1-800-682-9094 x81623 | |
| Personal Preference Program (PPP) | 1-855-465-4777 |
Community ResourcesCommunity Resources
| Resource | Service and Contact |
| 2-1-1 | Educate members on the benefits of dialing 2-1-1 on a telephone, 24 hours a day, seven days a week, to be connected to social service programs and crisis intervention hotlines. |
| Adult Protective Services (APS) | 1-800-792-8820, or NJ EASE 1-877-222-3737 |
| New Jersey Division of Developmental Disabilities (DDD) | 1-800-832-9173 DDD determines those who are eligible to receive services it funds through its application process. Generally, to receive services, you must show that you have a severe, chronic physical and/or mental impairment that:
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| Division of Child Protection and Permanency (formerly DYFS) | To report child abuse or neglect: 1-877-NJ ABUSE (652-2873) |
| NJ Addiction Services Hotline | There is help available for those who need assistance with a drug or alcohol problem. For assistance and a referral for treatment, the NJ Addiction Services Hotline can be reached toll-free at 1-844-276-2777. Help is available 24 hours a day, seven days a week. |
Availity Essentials is a product of Availity, LLC. Availity, LLC has contracted with Horizon Blue Cross Blue Shield of New Jersey and its affiliates in the administration of the provider portal. Availity, LLC is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.
