Horizon Blue Cross and Blue Shield of New Jersey
New Jersey • PPO, Medicaid, High-Deductible Health Plan (HDHP)
This prefix is associated with a PPO plan. Preferred Provider Organization coverage gives members flexibility to see specialists without referrals and to use out-of-network providers at higher cost-sharing. Claims can be submitted for both in-network and out-of-network services, though reimbursement rates differ.
Medicaid managed care under this BCBS prefix means the state has contracted with this plan to administer Medicaid benefits. Balance billing Medicaid members is prohibited. Timely filing requirements may follow state Medicaid rules rather than the plan's commercial deadlines. Contact the plan to confirm submission requirements.
HDHP (High-Deductible Health Plan) coverage means the member has a higher deductible than traditional plans, often paired with a Health Savings Account (HSA). Most services require the member to pay out-of-pocket until the deductible is met. Preventive care is typically covered before the deductible. Submit claims normally to the payer listed above.
Largest health insurer in New Jersey serving over 3.8 million members with commercial, Medicare and Medicaid plans.