Horizon BCBSNJ CCN Authorization Process Guide
This document provides essential information about the prior authorization and medical necessity processes for Horizon BCBSNJ members through CareCore National (CCN). It outlines the responsibilities of physicians, the services requiring authorization, and the procedure for obtaining necessary approvals before imaging services. Comprehensive instructions and timelines for authorization requests are included to assist healthcare providers.
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How do I fill this out?
To fill out this form, start by ensuring that you have the correct patient information ready. Next, contact CareCore National via the toll-free number or fax for prior authorization. Provide all requested clinical documentation during your communication to facilitate swift processing.
How to fill out the Horizon BCBSNJ CCN Authorization Process Guide?
1
Ensure you have the correct patient information.
2
Contact CareCore National at the toll-free number or via fax.
3
Provide all required clinical documentation.
4
Receive authorization number upon successful processing.
5
Schedule the procedure once authorization is confirmed.
Who needs the Horizon BCBSNJ CCN Authorization Process Guide?
1
Primary Care Physicians needing authorization for imaging services.
2
Specialists requiring prior approval for diagnostic tests.
3
Radiology facilities calling for updates on authorization status.
4
Patients who need to understand their imaging services cost.
5
Insurance providers managing claims for radiology services.
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What are the instructions for submitting this form?
To submit this form, you can call CareCore National at 1-866-496-6200 or fax your completed form to 1-800-637-5204. Ensure that all required documentation is included with your submission to avoid delays. You may also access the CCN website for further online guidance.
What are the important dates for this form in 2024 and 2025?
Important dates for prior authorizations in 2024 include January 1st for NJ PLUS members, with effective dates for Medicare plans beginning April 1st. Be sure to stay updated on any changes to procedures or requirements as they may affect your request timelines. Consult the guide regularly for any additional updates.
What is the purpose of this form?
The purpose of this form is to facilitate the prior authorization process for imaging services requested for Horizon BCBSNJ members. It establishes clear guidelines for healthcare providers to follow when seeking approval for advanced imaging services necessary for patient care. Ensuring compliance with these guidelines helps streamline the process and enhances service delivery.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Information: Details such as patient name, date of birth, and insurance information.
- 2. Physician Details: Information about the referring physician including name and contact number.
- 3. Imaging Procedure: Specification of the advanced imaging service being requested.
- 4. Clinical Information: Documentation supporting the medical necessity of the imaging procedure.
- 5. Authorization Request: The formal request for authorization to be reviewed by the CCN.
What happens if I fail to submit this form?
Failure to submit this form may result in delayed or denied authorization for necessary imaging services. Without approval, patients may face unexpected costs or the need to reschedule procedures. It is vital to ensure timely submission to avoid complications.
- Delayed Care: Patients may experience delays in receiving necessary imaging services if authorization is not obtained.
- Increased Costs: Patients may incur higher out-of-pocket expenses without proper authorization.
- Administrative Issues: Healthcare providers may face administrative challenges in processing claims without authorization.
How do I know when to use this form?
- 1. For Imaging Procedures: Use this form when requesting prior authorization for CT, MRI, or other imaging services.
- 2. For Clinical Necessity: Utilize this form to demonstrate the medical necessity of the imaging request.
- 3. For Insurance Compliance: Complete this form to comply with Horizon BCBSNJ's insurance requirements.
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What information do I need to fill out the form?
You need patient details and clinical information required for authorization.
How long does it take to get a response on authorization?
Typically, general requests are resolved within 48 hours, while urgent cases can be addressed within 3 hours.
What should I do if my authorization is denied?
We recommend contacting the CCN Peer to Peer Consultation Line for further discussion on the case.
Can I initiate a request online?
Yes, you can initiate a request through the CCN website, provided you have registered.
How is eligibility checked for members?
Eligibility can be checked on the CCN website through the Eligibility Lookup tool.
What are the operating hours for CCN?
CCN's support staff is available Monday to Friday from 7:00 a.m. to 7:00 p.m. ET.
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