Please mail the completed form within 12 months from the date of service to:įor information about the claim status or any other questions concerning your dental coverage, please call our dental customer service at 1-800-4DENTAL. Type of service provided/produced or item suppliedĭate each service was provided or item suppliedĪmount charged for each service provided or item supplied Health Care Professional's National Provider Identifier Number (NPI) Health Care Professional's Federal Tax Identification Number Name and address of person or institution providing the service or supplying the item To submit a dental claim for out-of-network services, you can download a claim form. New Jersey requires Providers to file claims on behalf of members, unless the person elects to file a claim themselves. Generally, since these dental plans require the use of in-network dentists for most covered dental services, there will be no need to file claims. and 6 p.m., Eastern Time (ET) and Thursday, between 9 a.m. Call Member Services at 1-800-355-BLUE (2583), Monday through Wednesday and Friday, between 8 a.m.Chat live with a Member Services Representative during normal business hours.You will receive a status of your inquiry within two business days Send your question through our secure Message Center.Horizon Blue Cross Blue Shield of New Jerseyįor information or status about a claim, you can: Please mail the completed claim form within 12 months from the date of service to: ( Note: Cash register receipts, cancelled checks, money order receipts, personal itemizations and bills only noting a “balance due” are not acceptable.) Amount charged for each service rendered or item supplied. ![]() Date each service rendered or item supplied.Type of service rendered/produced or item supplied.Health Care Professional's National Provider Identifier Number (NPI).Health Care Professional's Federal Tax Identification Number.Name and address of person or institution rendering the service or supplying the item.Itemized bills for covered services or supplies must be attached to the claim form and include the following information:.When you are submitting expenses for more than one family member, please use a separate claim form for each person.To submit a medical claim for out-of-network services, you can download a claim form. Participating doctors file claims directly to Horizon BCBSNJ on behalf of their patients. Remember, when you use a participating doctor, other health care professional or facility, you do not need to submit your claims. Members filing a medical claim for an out-of-network service are required to complete a claim form and submit it within 12 months from the date of service. ENROLLEE CLAIMS SUBMISSION Filing a Medical Claim ![]() Learn more about the importance of staying in network. If you receive any services that are not covered under your plan, you will be responsible for paying the doctor's total charges. This amount will not exceed the $100 allowed amount. ![]() Because your doctor has agreed to receive a discounted rate from Horizon BCBSNJ, the total amount your doctor can collect is our contracted payment, plus any applicable coinsurance or copayment from you. For example, if your participating doctor charges $200 for a service, and our allowed amount is $100 for that service, the participating doctor is not permitted to charge you the remaining $100. Participating doctors, dentists, other health care professionals and hospitals are not permitted to “balance bill” you for any difference between their charges and Horizon BCBSNJ's allowed amount for a covered service. Use our Doctor & Hospital Finder to look for a participating doctor, dentist, other health care professional or hospital. Additionally, non-participating providers can balance bill you up to their total charges. If you receive non-emergent services from a non-participating provider, you will have to pay the provider's total charges out of your pocket. There are no out-of-network benefits, except in emergency situations, for Individual consumers enrolled in the Horizon Advantage EPO or OMNIA Health Plans. For eligible dental services to be covered, members must use participating dentists in the dental PPO Network. Members in the medical plans must use doctors, other health care professionals and hospitals in the Horizon Managed Care Network. Horizon BCBSNJ is also offering three types of dental plans on the Individual Marketplace for 2023 – Horizon Young Grins, Horizon Family Grins and Horizon Family Plus. Horizon BCBSNJ is offering two types of medical plans on the Individual Marketplace for 2023 – Horizon Advantage EPO and OMNIA Health Plans. OUT-OF-NETWORK LIABILITY AND BALANCE BILLING
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