Horizon Provider Resources

Effective 6/6/22, Horizon BCBSNJ is de-implementing the Spine Surgery Prior Authorization/MND Program, along with 10 Spinal implants that fall under our Pain Prior Authorization/MND program to include CPT Codes: 63650, 63655, 63663, 63664, 63685, 62350, 62351, 62360, 62361, 62362.

Outpatient Spine Surgery Retroactive/post service requests would be allowed for Date of services 6/5/22 and prior.

We will continue to process Radiology, Cardiology, Radiation Therapy, Molecular and Genomic diagnostic laboratory testing and Pain Prior Authorization/MND Programs (with the exception of the 10 CPT codes mentioned above) for Horizon BCBSNJ

You may already be aware that EviCore healthcare currently provides authorization services for Radiology, Cardiology, Radiation Therapy, and Laboratory Management for Horizon Blue Cross Blue Shield of New Jersey, including Medicare membership.

EviCore is pleased to grow this partnership with Horizon NJ Health, providing authorization services for members enrolled in NJ FamilyCare, Horizon NJ TotalCare (HMO SNP), & Managed Long Term Services and Supports (MLTSS) for Radiology, Cardiology, and Radiation Therapy services. Beginning December 16, 2019, providers will submit precertification requests through EviCore healthcare for dates of service January 1, 2020 and thereafter.

Additionally, please click here to learn more about the Horizon NJ Health Medicaid and SNP expansion for 1/1/2020.