Horizon Blue Cross and Blue Shield of New Jersey
New Jersey • POS, HMO, Medicare Advantage
POS coverage under this prefix operates on a tiered system. Tier 1 (in-network with referral) provides the highest coverage. Tier 2 (in-network without referral) provides moderate coverage. Tier 3 (out-of-network) provides the lowest coverage. Verify which tier applies before submitting the claim.
This is a Health Maintenance Organization (HMO) prefix. HMO plans have stricter routing requirements than PPO plans. Members select a PCP who manages their care and issues referrals. Claims for specialist services should include the referral number. Out-of-network claims will typically be denied unless emergency criteria are met.
This prefix includes Medicare Advantage coverage. MA plans follow CMS guidelines for timely filing (365 days from date of service), which may differ from the commercial plan's deadline. The payer ID for Medicare Advantage claims may differ from the standard commercial payer ID. Verify before submitting.
Largest health insurer in New Jersey serving over 3.8 million members with commercial, Medicare and Medicaid plans.