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What does Horizon BCBSNJ hope to accomplish by having these programs?
The goal of our programs is to provide educational tools for our members to better manage their conditions and lead a better quality of life in collaboration with their physician's plan of care.
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Can I (the provider) enroll them?
Yes, you can. Call us at 1-888-333-9617, or fax the information to 1-888-450-4044, or mail your correspondence to: Horizon Health and Wellness Education Programs, Three Penn Plaza East, PP-13X, Newark, New Jersey 07105-2200. Please indicate which programs you are referring member(s) to.
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Can you refuse to enroll a patient of mine into a program?
We would not refuse eligible members (refer to the following question).
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Who is eligible?
ASTHMA HEALTH EDUCATION PROGRAM:
All fully insured members 5 years of age and older diagnosed with asthma and enrolled in the following products-Horizon HMO, Horizon PPO, Horizon POS, Horizon Direct Access, Medicare Advantage (includes Horizon Medicare Blue, Horizon Medicare Blue Plus, Horizon Medicare Value Plus), and eligible national PPO accounts. (Members can call 1-888-334-9006.)
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) HEALTH EDUCATION PROGRAM:
All fully insured members 30 years of age and older diagnosed with COPD (includes chronic bronchitis and emphysema) and enrolled in the following products-Horizon HMO, Horizon PPO, Horizon POS, Horizon Direct Access, Medicare Advantage (includes Horizon Medicare Blue, Horizon Medicare Blue Plus, Horizon Medicare Value Plus), and eligible national PPO accounts. (Members can call 1-888-334-9006.)
DIABETES HEALTH EDUCATION PROGRAM:
All fully insured members 18 years of age and older diagnosed with diabetes and are enrolled in the following products-Horizon HMO, Horizon PPO, Horizon POS, Horizon Direct Access, Medicare Advantage (includes Horizon Medicare Blue, Horizon Medicare Blue Plus, Horizon Medicare Value Plus), and eligible national PPO accounts. (Members can call 1-888-334-9006.)
CORONARY ARTERY DISEASE HEALTH EDUCATION PROGRAM:
All fully insured active members 18 years of age and older who have been hospitalized for cardiovascular conditions like Angina, Heart attack (AMI - acute myocardial infarction) or had procedures such as CABG (Coronary Artery Bypass Graft surgery), PTCA (Percutaneous Transluminal Coronary Angioplasty) and Stent and enrolled in the following products- Horizon HMO, Horizon PPO, Horizon POS, Horizon Direct Access, Medicare Advantage (includes Horizon Medicare Blue, Horizon Medicare Blue Plus, Horizon Medicare Value Plus), and eligible national PPO accounts (Members can call 1-888-334-9006.)
CHRONIC KIDNEY DISEASE (CKD) AND END STAGE RENAL DISEASE (ESRD) HEALTH EDUCATION PROGRAM:
All fully insured members 18 years of age and older diagnosed with chronic kidney disease (CKD) and End Stage Renal Disease (ESRD) and are enrolled in the following products- Horizon HMO, Horizon PPO, Horizon POS, Horizon Direct Access, Medicare Advantage (includes Horizon Medicare Blue, Horizon Medicare Blue Plus, Horizon Medicare Value Plus), and eligible national PPO accounts (Members can call 1-888-334-9006.)
HEPATITIS C HEALTH EDUCATION PROGRAM:
All fully insured members 18 years old diagnosed with Hepatitis C , and are enrolled in the following products - Horizon HMO, Horizon PPO, Horizon POS, Horizon Direct Access, Medicare Advantage (includes Horizon Medicare Blue, Horizon Medicare Blue Plus, Horizon Medicare Value Plus), and eligible national PPO accounts (Members can call 1-888-334-9006.)
HEART FAILURE HEALTH EDUCATION PROGRAM:
All fully insured members 18 years old diagnosed with Heart Failure and are enrolled in the following products - Horizon HMO, Horizon PPO, Horizon POS, Horizon Direct Access, Medicare Advantage (includes Horizon Medicare Blue, Horizon Medicare Blue Plus, Horizon Medicare Value Plus), and eligible national PPO accounts (Members can call 1-888-334-9006.)
MULTIPLE SCLEROSIS HEALTH EDUCATION PROGRAM:
All fully insured members 18 years old diagnosed with the Multiple Sclerosis, and are enrolled in the following products - Horizon HMO, Horizon PPO, Horizon POS, Horizon Direct Access, Medicare Advantage (includes Horizon Medicare Blue, Horizon Medicare Blue Plus, Horizon Medicare Value Plus), and eligible national PPO accounts (Members can call 1-888-334-9006.)
WEIGHT MANAGEMENT HEALTH EDUCATION PROGRAM:
All fully insured members 12 years old diagnosed with Obesity, and are enrolled in the following products - Horizon HMO, Horizon PPO, Horizon POS, Horizon Direct Access, Medicare Advantage (includes Horizon Medicare Blue, Horizon Medicare Blue Plus, Horizon Medicare Value Plus), and eligible national PPO accounts (Members can call 1-888-334-9006.)
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Can a PCP or a Specialist enroll a patient?
The Specialist or PCP can enroll a patient in the program. (Please refer to the fourth question, "Who is eligible?")
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If a Specialist or patient self-enrolls, does the PCP get notified?
Yes.
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Does a patient need to identify his/her physician when he/she enrolls?
Yes.
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How long are they enrolled in a program?
Members will continue to be enrolled in the programs and will not be removed until they choose to do so.
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Can patients terminate their enrollment in a program?
Members can disenroll by calling the Horizon Health and Wellness Education Programs at 1-888-334-9006. Failure to participate in or termination from a program will not affect a member's benefits under his/her Horizon BCBSNJ plan.
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Where can I get enrollment/educational materials for my patients?
By calling 1-888-333-9617 or faxing 1-888-450-4044 a request for materials.
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Would I be able to speak with a Medical Director?
Yes, through the provider toll-free number, the team leader will connect you to the Medical Director.
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Will enrolling patients in the program add more paperwork for my staff and myself?
No.
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Is there any financial reward for a doctor who encourages patients to participate?
No, not at present, but we are looking into providing incentives for providers.
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What if I disagree with the clinical information you are giving to my patient? Will this program interfere with my care of my patient?
This program will not interfere with the care of your patient. The program reinforces your clinical information and goals given to your members. If you disagree with the clinical information, you can either call the toll-free provider line and speak with the team leader, send your correspondence via fax, or mail to: Horizon Health and Wellness Education Programs, Three Penn Plaza East, PP-13X, Newark, New Jersey 07105-2200.
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Can I be given a summary of what interactions the Horizon Health and Wellness Education Programs have had with my patient (i.e., date enrolled, date mailed info, etc.)?
Yes.
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Will I have to deal with AdvancePCS (Horizon BCBSNJ's pharmacy benefits manager), and will they interfere with my prescriptions?
Physicians must interact with AdvancePCS, as you normally would according to members' plan benefits. The Health and Wellness Education Programs will not interfere with the prescribing process. The programs are intended to facilitate the patient's access to all appropriate care, including proper medication and improving patient compliance.
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Can I get feedback on the effectiveness of the programs?
Yes, outcome reports will be provided on a quarterly and annual basis in aggregate form. Please call us at 1-888-333-9617 for more information.
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