For your convenience, Horizon Blue Cross Blue Shield of New Jersey is please to offer answers to frequently asked questions we receive about the BlueCard Program.

Q1. What is the difference between the Home Plan and the Host Plan?

A1. The Home Plan is the Blue Cross and/or Blue Shield Plan through which the member is enrolled.
The Host Plan is the Blue Cross and/or Blue Shield Plan in the area where services are rendered.


Q2. Whom do I contact for information on a BlueCard member’s eligibility and benefits?

A2. For eligibility and benefit information, contact the member’s Blue Plan by calling 1-800-676-BLUE (2583).


Q3. Whom do I contact for information on a BlueCard claim?

A3. For claims and claims-related questions, Horizon BCBSNJ’s Dedicated BlueCard Physician Unit can be
reached at 1-888-435-4383. This Unit is your source for all claims and claims-related questions.


Q4. Whom do I contact for precertification of out-of-state services?

A4. The member is responsible for securing prior authorization and precertification, when required. You may
do this on behalf of the member by calling 1-800-676-BLUE (2583).


Q5. Are prefixes required when submitting BlueCard claims?

A5. Yes, prefixes are always required when submitting claims to Horizon BCBSNJ. The prefix enables us to
route your claim to the appropriate team for handling.


Q6. What is the correct address for BlueCard claims?

A6. You should submit all claims electronically; doing so helps expedite our payment to you. If you must
submit paper claims for BlueCard, mail them to:
Horizon BCBSNJ
BlueCard Claims
PO Box 1301
Neptune, NJ 07754-1301
Please mail all other correspondence, including appeals and corrected claims, to the address listed above.


Q7. Why do you pend an entire claim when there is a problem with only one item?

A7. For audit purposes, Horizon BCBSNJ must either accept or reject a claim as originally submitted.
Additionally, one item can impact the payment of the entire claim. For example, when a claim is
submitted for surgery, and the physician or other health care professional bills with an invalid surgical
procedure code and there are multiple surgical procedure codes listed on the claim, the invalid procedure
code may impact payment. Therefore, the entire claim has to be pended in order to process it correctly.


Q8. Where should claims be sent for prefix NJX?

A8. NJX is the prefix for the New Jersey State Health Benefits Program’s NJ DIRECT plan. NJ DIRECT
members have BlueCard benefits when receiving services outside of New Jersey. As a Horizon BCBSNJ
participating physician or other health care professional, when rendering services in New Jersey to a
NJ DIRECT member, file claims with Horizon BCBSNJ as instructed on the member’s ID card.
(Over, please)
For your convenience, Horizon Blue Cross Blue Shield of New Jersey is pleased to offer
answers to frequently asked questions we receive about the BlueCard Program.


Q9. My office staff is still having challenges discerning between BlueCard claims and
National Accounts claims.

A9. The BlueCard Program is the Blue Cross and Blue Shield Association’s national program that enables
members to receive health care services while traveling or living in another Blue Plan’s service area.
Members who have BlueCard benefits can be identified by three key elements on their ID cards:
• Another Blue Plan’s name and Blue Cross and/or Blue Shield Plan logo.
• The PPO in a suitcase logo or the blank suitcase logo.
• The three-letter alpha prefix.
If the Horizon BCBSNJ Plan name or 3HZN appears on the member’s ID card, then the member’s benefits
are not eligible for BlueCard processing when services are rendered in New Jersey. You should submit
claims for these patients as you would for all other Horizon BCBSNJ patients.


Q10. Should claims for members with coverage from Empire Blue Cross Blue Shield (BCBS) be
submitted directly to Empire BCBS, or should I submit these claims through BlueCard?

A10. If you are treating an Empire BCBS member and you contract with Horizon BCBSNJ and Empire BCBS,
file the member’s claim directly with Empire.
If you are treating an Empire BCBS member and services are rendered in New Jersey and you contract only
with Horizon BCBSNJ, file the member’s claim with Horizon BCBSNJ for BlueCard claim processing.


Q11.We currently participate with Independence Blue Cross, AmeriHealth and Keystone.
Can we submit claims for all three plans through BlueCard?

A11. If you are treating an Independence Blue Cross member and you contract with Horizon BCBSNJ and
Independence Blue Cross, file the member’s claim directly with Independence Blue Cross.
If you are treating an Independence Blue Cross member and services are rendered in New Jersey and
you contract only with Horizon BCBSNJ, file the member’s claim with Horizon BCBSNJ for BlueCard
claim processing.
For AmeriHealth and Keystone, refer to the member’s ID card for the appropriate claims filing instructions.


Q12. Is it possible to receive a list of phone numbers for the different plans to pre-authorize
radiology services?

A12. Unfortunately, at this time, an all-inclusive list of radiology authorization contact numbers is not available.
We ask that you call 1-800-676-BLUE (2583) for specific member eligibility and benefit information.
A knowledgeable representative will assist you.


Q13.We are having problems with BlueCard as a secondary payer to Medicare. When claims
are forwarded electronically to BlueCard as secondary, they are sent to the Home Plan, and
we cannot get assistance from BlueCard with payment issues.

A13. Call our Dedicated BlueCard Physician Unit at 1-888-435-4383. A representative will assist you with any
claims-related questions, including Medicare issues. Our experienced BlueCard representatives will work
directly with the member’s Home Plan, on your behalf, until your questions are resolved.
For additional information on the BlueCard Program, visit our Web site at www.HorizonBlue.com or the
Blue Cross and Blue Shield Association Web site at <www.BCBS.com>.


If you have additional BlueCard questions, please call our Dedicated BlueCard Physician Unit at 1-888-435-4383.