New Jersey Medicaid Contract: Horizon Nj Health January 1 2019
New Jersey contracts with five health plans to deliver physical health and long-term services and supports for most populations, including families and children, Medicaid expansion adults, and aged and disabled adults. All but one health plan is available statewide. Individuals have a choice of plans in their county. Contracts for the five health plans are available for download.
This New Jersey Medicaid Contract is for Horizon NJ Health, signed January 1, 2019.
For more information on New Jerseys Medicaid managed care programs, and to view other contracts, visit New Jersey Medicaid Managed Care Contracts.
Before You Buy
All products are included with an Elite Membership! Be sure to check out our membership levels to see all the included features and products!
Number of items in cart: 0
- Your cart is empty.
Horizon Nj Health Addiction Treatment Coverage
Horizon NJ covers over 500,000 children and adults in the NJ FamilyCare and Medicaid programs. Horizon NJ is also the largest managed healthcare company in New Jersey.
Horizon NJ offers four healthcare plans, including:
- Horizon NJ TotalCare
- Managed Long-Term Services & Supports
- Medicaid Managed Care
- NJ FamilyCare
Each Horizon NJ healthcare plan is unique and offers various levels of care. While the elements of each plan determine the out-of-pocket cost for addiction treatment. Depending on the participating healthcare plan, treatment could have zero out-of-pocket expenses.
Representatives at Horizon NJ are always available to answer any coverage questions. However, at Discovery Institute, we know peoples focus should be on recovery. And, since we are in-network providers, we work closely with Horizon NJ to get you the best, most affordable treatment.
Will Horizon Nj Pay For Drug Rehab
Horizon NJ TotalCare and Managed Long-Term Services & Supports are two healthcare plans from Horizon NJ that cover substance use disorder treatment. However, other members of Horizon NJ healthcare plans may also have treatment coverage.
For instance, Horizon NJ offers fee-for-service plans. A fee-for-service plan through Horizon NJ may require members to pay for specific treatments or therapies. Substance use disorder treatments typically covered by Horizon NJ include:
- Medical detox programs
- Medication Management
Horizon NJ members struggling with an opioid use disorder, each plan typically covers Subutex, Suboxone, and other medications in this class. Depending on the healthcare plan, members may pay as little as $5 for medications. Some healthcare plans fully cover the cost of Methadone, while others may offer a fee-for-service.
Because getting into treatment right away is crucial, our team works quickly with Horizon NJ to verify benefits and get members into treatment. We also advocate for Horizon NJ members entering treatment to maximize their treatment benefits.
Recommended Reading: Medicaid Doctors In Baton Rouge
Horizon Blue Cross Blue Shield Of New Jersey Expands Horizonbfit Program That Pays Members Who Stay Fit
NEWARK Horizon Blue Cross Blue Shield of New Jersey announced today that it will expand its popular HorizonbFit fitness rewards program to large, self-funded employers. The innovative HorizonbFit program offers reimbursements of $20 per month to members who enroll and visit a participating fitness facility at least 12 days per month. Members can earn up to $240 a year in rewards.
Exercise is vitally important to staying fit and healthy and lowering health care costs, and employers are looking for innovative programs to encourage workers to take charge of their health, said Christopher M. Lepre, senior vice president of Market Business Units at Horizon BCBSNJ. Rewards programs, such as HorizonbFit, work to encourage healthy behaviors, and we wanted our larger customers to have access to this great program.
Initially offered as a benefit in May of 2013 to fully-insured mid-sized and public sector groups, self-funded, large employers and national accounts can now purchase the HorizonbFit program for their employees. Employers find that rewards encourage more employees to participate in wellness programs. The HorizonbFit fitness reimbursement program offers:
Visits to gyms and reimbursements are tracked electronically Easy to use for members who not have submit any paperwork for rewards.
For additional information about HorizonbFit, employers should contact their Horizon BCBSNJ sales representative.
About Blue Cross Blue Shield Association
The Blue Cross and Blue Shield Association is a national federation of 35 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. BCBSA provides health care insights through The Health of America Report series and the national BCBS Health Indexsm. For more information on BCBSA and its member companies, please visit BCBS.com. We also encourage you to connect with us on , check out our videos on and follow us on .
The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.
Horizon Nj Health To Stop Reimbursing 98943
Horizon NJ Health, Horizons Medicaid managed care subsidiary, has announced that it will no longer reimburse CPT code 98943, extra-spinal manipulation, as of . to see the announcement in full.
Further, the announcement states that the only services rendered by a chiropractor that will be reimbursed are manual manipulation of subluxation of the spine billed under CPT codes 98940, 98941 and 98942.
Despite this assertion, the Horizon NJ Health Provider Manual does declare that an initial evaluation billed under codes 99201-99205 is eligible for payment when billed on the initial visit with appropriate PCP referral.
You can find the Provider Manual here .
Association of New Jersey Chiropractors 77 Brant Avenue, Suite 210 Clark, NJ 07066
Horizon Nj Health Rates As New Jersey’s Top Medicaid Managed Care Plan
Horizon NJ Health, a subsidiary of Horizon Blue Cross Blue Shield of New Jersey, is the highest rated Medicaid managed care plan among all of the state’s participating Medicaid plans. According to the NJ FamilyCare/Medicaid “HMO Performance Report” released last month, Horizon NJ Health received a 92% overall performance score, the highest of all New Jersey’s Medicaid managed care plans and the only plan to improve its overall score from previous reports.
The NJ FamilyCare/Medicaid “HMO Performance Report” for 2010 provides information on the quality of each health plan’s performance that includes the quality of care provided to clients, client satisfaction levels in their health plans and the performance of internal operations of all plans.
“This is great news,” said Karen L. Clark, Vice President Medicaid, Horizon Blue Cross Blue Shield of New Jersey, President, Horizon NJ Health. “The performance report validates our commitment to our members and providers. To be rated as the highest among all of the plans serving New Jersey residents confirms our efforts and the trust our members place in us to consistently deliver quality, accessible care for more than a half a million lives. We are honored and will continue our efforts on behalf of our members.”
Horizon NJ Health received the best overall compliance score and had the highest ratings in:
- Childhood Immunizations
Read Also: Change My Ohio Medicaid Plan
Best Health Insurance Companies : Horizon Bcbs Of New Jersey
Horizon Blue Cross Blue Shield of New Jersey is headquartered in Newark, New Jersey, and is the only licensed Blue Cross and Blue Shield Association plan in New Jersey. BCBS of New Jersey provides health insurance coverage to over 3.2 million people throughout all of New Jersey.
BCBS of New Jersey is part of the Blue Cross Blue Shield association. This is a national association of 36 independent, community-based and locally operated Blue Cross Blue Shield companies. The BCBS association provides healthcare coverage to over 107 million members in all 50 states, Washington, D.C., and Puerto Rico. Nationwide, over 96 percent of hospitals and 95 percent of doctors and specialists contract with Blue Cross Blue Shield companies which is more than any other insurer in the country.
How Much Does Treatment Cost With Horizon Nj Insurance
Horizon NJ covers a variety of substance use and mental health disorder treatments. However, the level of coverage depends on several factors. These factors include:
- The healthcare plan through Horizon NJ
- The length of treatment
- The length of substance misuse
- The form of treatment
Inpatient or residential treatment requires staying in the rehab center, which uses more resources. While inpatient treatment is often more effective, it also has a higher price than outpatient treatment. Because outpatient treatment permits individuals to live at home, it tends to cost less out-of-pocket.
Verifying insurance benefits beforehand is crucial. You can verify your insurance benefits and coverage for treatment at Discovery Institute here. Or, you can verify coverage through the Horizon NJ website.
Also Check: Therapists Baton Rouge Accept Medicaid
Will Horizon Nj Cover Dual Diagnosis Treatment
A dual diagnosis is typically a diagnosis of both a substance use disorder and a mental health disorder. Co-occurring disorders such as alcohol use disorder and bipolar disorder require more intensive treatment. For instance, co-occurring disorders are treated simultaneously but separately.
Because substance use disorder and mental health disorders often co-occur, individuals are evaluated for any co-occurring disorders when entering treatment. For this reason, choosing a healthcare plan through Horizon NJ is essential.
Depending on the level of coverage, treatment of co-occurring disorders may be covered through Horizon NJ. Coverage may include short-term rehab, long-term treatment, and sober living homes.
Does Horizon Nj Cover Detox Programs
Misusing substances such as drugs and alcohol can chemically change a persons brain. These changes can make it extremely dangerous to stop using the substance all at once. Quitting cold-turkey sends the body into withdrawals and can lead to severe consequences.
In a detox program, individuals are medically supervised and receive medications to ease withdrawal symptoms. Withdrawal symptoms may vary from mild to severe and include:
- Increase heart rate
However, detox is the first step in recovery. So, after detox, members continue treatment in either inpatient or outpatient programs. Horizon NJ may also cover the majority or all of treatment, depending on the level of coverage.
Recommended Reading: United Health Care Managed Medicaid
What Is This Rating
A.M. Best’s Financial Strength Rating is an independent opinion of an insurer’s financial strength and ability to meet its ongoing insurance policy and contract obligations.
A.M. Best’s rating is NOT used to calculate the overall score but it is important information to consider when choosing an insurance company.
Inpatient And Outpatient Addiction Treatment Coverage
There are two types of addiction treatment, inpatient and outpatient treatment. While in an inpatient or residential treatment, members live in the facility. By taking away the stress of daily life, it increases self-confidence and long-term recovery.
Outpatient treatment is another common treatment type. Members in this program still go to work and handle their responsibilities. Furthermore, members in outpatient treatment live at home. Because outpatient treatment typically costs less, Horizon NJ may cover the cost of treatment.
When choosing a Horizon NJ healthcare plan, choosing one that covers both inpatient and outpatient treatment is something to consider. Horizon NJ TotalCare plans generally cover the cost of in-network addiction treatment. At the same time, their other plans may offer a fee-for-service plan.
Also Check: Does Maryland Medicaid Cover Abortions
Horizon Nj Insurance For Addiction Treatment
Horizon NJ Health Addiction Treatment Coverage
Reviewed by Dr. Jeffrey Berman, MD
New Jersey Drug & Alcohol Rehab / Horizon NJ Insurance for Addiction Treatment
Get started on your road to recovery.
In 2019, the New Jersey Department of Human Services reported people sought addiction treatment 98,628 times. If you are struggling with an addiction to drugs or alcohol and participate in Horizon NJ Health insurance, your healthcare plan may cover the treatment.
New Jersey is no different from the rest of the world when it comes to the drug epidemic. For example, in 2018, The Attorney Generals office reported 3,163 people suffered a fatal overdose. This number is four times higher than ten years ago.
Because of the concerning increase in fatalities, insurers like Horizon NJ are committed to working with comprehensive and affordable treatment centers such as Discovery Institute.
Medicaid Reimbursement And Billing
Out-of-State Medicaid Claims for Blue Cross Blue Shield Association PlansState Medicaid agencies contract with Blue Cross and/or Blue Shield Plans as Managed Care Organizations to provide comprehensive Medicaid benefits on a risk basis. Both federal and state regulations guide these relationships, but the eligible population, covered benefits and specific rules regarding each states Medicaid program may differ from state to state. Many state Medicaid programs require providers to enroll as Medicaid providers with that states Medicaid agency before payment can be issued. In other cases, a state Medicaid program will accept a providers Medicaid enrollment in the state where the provider practices.
Medicaid Reimbursement and BillingClaims for all Horizon NJ Health Medicaid members should be submitted to your local BCBS Plan.
If you are contracted with Horizon NJ Health, your Medicaid rates will only apply for services provided to Horizon NJ Health members. These rates do not apply to services provided to out-of-state Medicaid members.
When you provide services to a Medicaid member from another state, you must accept that states Medicaid allowance as payment in full. Please note that billing out-of-state Medicaid members for any amounts in excess of the Medicaid-allowed amount for Medicaid-covered services is specifically prohibited by federal regulations .
As a reminder, applicable Medicaid claims submitted without these data elements will be denied.
How Horizon Bcbs Of Nj Stacks Up
Horizon BCBS of New Jersey earned a 4 out of 5-star rating in our annual Best Health Insurance Companies review with 3.5 and 4 stars across the board in claims, price, customer service and website & apps.
When we asked Horizon BCBS customers if they would recommend them to others, 83% said yes. Ninety-eight percent of Horizon BCBS customers said they planned to renew their health plan with Humana.
Discovery Institute And Horizon Nj Insurance Can Help You Find Recovery
Our team at Discovery Institute is here to help you find comprehensive and affordable addiction treatment. With our dedicated therapists and holistic therapies and your coverage through Horizon NJ, a life free of drugs and alcohol is a phone call away.
If you or a loved one struggles with addiction but doesnt think its affordable, we can help. Contact us today and find out more.
Reviewed for Medical & Clinical Accuracy by Dr. Jeffrey Berman, MD
Dr. Jeffrey Berman is a psychiatrist in Teaneck, New Jersey and is affiliated with Robert Wood Johnson University Hospital. He received his medical degree from State University of New York Upstate Medical University and has been in practice for more than 20 years. He also speaks multiple languages, including French and Hebrew.
You May Like: Medicare And Medicaid Act Of 1965