Managed Care Organization
|
Provider Relations Telephone Number
|
Pre-certification Telephone Number
|
AETNA
(Merged w/NYLCARE)
Aetna
Provider
Facility/ Provider ID#
221775306
Aetna NAVINET
NAVINET
Portal Registration
and Questions
1-856-638-2701
https://navinet.navimedix.com
Aetna Website
http://www.aetna.com/ |
Janine Urquhart-Wilson
Hospital & Ancillary
Network Management
732-905-6701
Viola A. Smith
Implementation Specialists
Provider E Services for NJ
1-302-378-1593
HMO Based Benefits Plans
1-800-624-0756
Indemnity & PPO
Based Benefits Plans
1-888-632-3862
Dialysis Visits
1-866-503-0857
or
fax applicable request forms
1-888-267-3277
Beginning Right
Maternity Program
Including Genetic Testing,
Antenatal Testing,
Prenatal Consultations
& Counseling
1-800-272-3531
National Medical
Excellence program
For All Major Organ
Transplant Evaluations
&
Transplants including
but not limited to
Kidney, Liver, Lung,
and Pancreas,
&
Bone Marrow
Replacements
1-877-212-8811
Pediatric Congenital
Heart Surgery Program
See the Member’s ID Card
to Contact
The Precertification Unit
Aetna
Paper Claims Address
Aetna Life Insurance Company
P.O. Box 981107
El Paso, TX 79998-1107
www.aetna.com
|
Aetna
Patient Management
Department
HMO Based
1-800-624-0756
Aetna Medicare
HMO Plan
1-800-624-0756
Aetna Select Plan
1-888-632-3862
Open Choice
PPO & Traditional
1-888-632-3862
Managed Choice
POS & Elect
Choice EPO
1-800-223-6857.
(8 a.m. – 5 p.m.)
Aetna Affordable
Health Choices (PPO)
1-888-772-9682
Aetna Medicare
Advantage Plans
1-888-632-3862
Aetna Medicare
Open Plan (PFFS)
1-800-624-0756
Local 835
Magellan
Behavioral Health
1-800-424-4506
Aetna Pharmacy
Management for
Pre-certification
of Oral Medications
Only
1-800-414-2386
Aetna Specialty Pharmacy
for Information
on Injection Medications
1-866-782-2779
Aetna Laboratory
Services Must
be Rendered @
Quest Diagnostics
1-800-377-8448 (Locate Facility)
1-888-277-8772 (Appointments)
http://www.questdiagnostics.com/
Moms-To-Babies
Maternity
Management Program,
Including Genetic Testing,
Antenatal Testing,
Prenatal Counseling
1-800-272-3531
Aetna Beginning Right Program
Maternity program,
Including Genetic Testing,
Antenatal Testing,
Prenatal Consultations
&
Counseling
1-800-272-3511
Aetna
Infertility Program
1-800-575-5999
High End Radiology
Pre-certification for
Elective Outpatient
Care Core National
1-845-298-8155
Fax- 1-845-918-8924
http://www.carecorenational.com
Aetna National
Medical Excellence
Program
for all Major Organ
Transplant Evaluations
and Transplants
Including but not Limited
to Kidney, Liver, Heart, Lung
and Pancreas, and Bone Marrow
Replacement or Stem
Cell Transfer after
High Dose Chemotherapy.
1-877-212-8811
(Metro NY/ Northern NJ )
For HMO –Based Plan Members
Only: Out- Patient Physical
and Occupational Therapy
Pre-Certification
through
Orthonet
1-800-771-3205
Sleep Care Centers
1-800-753-3779
Aetna Pharmacy Management
1-800-238-6279
Aetna Alcohol
SBIRT@aetna.com
1-800-848-4876 Option 2
|
AMERIGROUP
Community Care
AMERIGROUP
Facility
Provider ID #
10076301
AMERIGROUP
Medicare Products
(NON PAR)
Authorizations Required
Must Contact
Care Management Services
AMERIGROUP
Website Address:
www.amerigroupcorp.com/providers
|
AMERIGROUP
Provider Inquiry Line (IVR)
1-800-454-3730
check claims status,
eligibility and authorizations
AMERIGROUP
Members Services Department
1-800-600-4441
Marsha A Gittens-Lee
Hospital Provider
Relations Contractor
732-744-6310
Fax # -1866-920-5994
Email: mlee002@amerigroupcorp.com
AT&T Relay
Service
1-800-855-2880
Tonya Pinckney
Provider Relations
Representative
732-452-6000 Ext 66109
Fax: (866)-920-5996
Cell: 732-692-0867
Providers Services
1-800-454-3730
(Medicaid & SCHIP)
1-866-805-4589
(Medicare)
Member Services
1-800-600-4441
(Medicaid & CHIP)
1-866-805-4589 (Medicare)
1-800-855-2880 (TTY)
Electronic
Data Interchange (EDI)
1-800-590-5745
Web Technical
Support
1-800-600-4441
option 5
Office of Business Ethics
Lori-Don Gregory
Deputy Chief Compliance Officer
Ombudsman Line
1-800-600-4441
TTY1-800-855-2880 Extension 34925
Main Corporate Office
757-490-6900
|
AMERIGROUP
Case
Management
Services
1-800-454-3730
AMERIGROUP
Preauthorization Fax Number
1-800-964-3627
AMERIGROUP
24/7/365
Nurse Helpline
1-800-600-4441
Laboratory Services
Must be Rendered
Lab Corp
800-845-6167
https://www.labcorp.com
Disease Centralized
Care Unit
(DMCCU)
1-888-830-4300
Radiology Management
National
Imaging Associates
1-800-642-7565
http://www1.radmd.com
Behavioral
Health Information
Fax#: 1-800-505-1193
Vision Care (Routine)
Members Contact
Block Vision
1-800-428-8789
AMERIGROUP
Transportation
1-866-527-9933
NJ Family Care B,C, and D
members are ineligible for routine
Transportation generally
Pharmacy
Care Mark
Customer Service
1-800-5528159
https://www.caremark.com/
Care Mark (Pharmacy)
Customer Service
Technical Support
800-241-2784
|
*** United HealthCare ***
COMMUNITY PLAN
(Formerly AMERICHOICE)
United
HealthCare
Community Plan
(formerly AMERICHOICE)
Provider ID # 221775306
United HealthCare
Community Plan
Website Address:
http://www.uhccommunityplan.com
|
Provider Relations
& Member Eligibility
1-888-362-3368
Member Service Center
1-800-941-4647
or TDD
1-800-852-7897
Member Service
Is Available 24 Hours a day,
7 days a Week
Hospital Provider
Representative
Edwin Soto
732-623-1952
United HealthCare Community Plan
Medical Professional Line
1-877-842-3210
Personal Care Model
1-888-362-3368
United HealthCare Community Plan
Medicare Solutions
1-877-459-4458
EDI
1-800-210-8315
Select Option 1
Dental Services
Unit
1-888-362-3368
Credentialing Inquiries
1-888-362-3368
Member Help Lines
Medicaid, NJ Family Care
1-800-941-4647
Unity Community Care
Personal Care Plus
(Medicare)
1-800-514-4911
United Healthcare
Community Plan
Claims Submission
Address:
PO Box 5250
Kingston, NY 12402-5250
Portal Web Site:
www.UHCDualComplete.com
United Healthcare Community Plan
Grievance and Appeals Department
P.O. Box 31364
Salt Lake City , UT 84131
|
United HealthCare
Community Plan
Health Services
Medical /Surgical
1-888-362-3368
Fax# 973-565-5255
United HealthCare
Community Plan
Special Needs and Care
Management Referral
Hotline
1-877-704-8871
Ext: 5260
For Providers to refer high-risk
Members to the Care
Management program
United HealthCare
Community Plan
Laboratory Services
Must be Rendered @
Lab Corp
1-800-245-6167
https://www.labcorp.com/
Radiology
Management
Med Solutions
888-693-3211
Fax: 888-693-3210
All MRI, MRAs,
CTs, PETs,
and Nuclear Studies
Require Prior Authorization
https://www.medsolutionsonline.com
Maternity/Newborn
1-866-820-6667
Fax : 1-973-565-5132
Mental Health &
Substance Abuse Vision
1-888-362-3368
Behavioral Health
1-888-362-3368 #4
Fax : 1-212-898-8368
Pharmacy Prior
Authorizations
1-800-711-4555
(Monday - Friday 9am-9:00pm)
Out of Plan Referral
or Referral too
Non Participating
Providers
1-888-362-3368
Option # 2 |
** AMERIHEALTH,
Inc ***
Medicaid
product
brought by Mercy
****AmeriHealth****
Contract Terminated
with University Hospital
November 9, 2010
AMERIHEALTH
Provider
Facility
Identification #
004566
&
221775306
AMERIHEALTH
Website Address:
www.amerihealth.com
|
Kim Miller
Hospital Service Coordinator
856-778-6545
Email
kim.miller@amerihealth.com
AMERHEALTH Mercy
Main office Telephone
1-877-693-8271
Provider Services
HMO
Policies
Procedures/Eligibility/Claims
1-800-275-2583 Prompt 2
AMERIHEALTH
Administrators
Provider Relations
1-800-841-5328
provrelations@amerihealth-tpa.com
Customer Service
Member Service
AMERIHEALTH HMO
Mon-Fri: 8 a.m. – 6 p.m.
800-275-2583
AMERIHEALTH PPO
800-422-2457
AMERIHEALTH 65
800-645-3965
AMERIHEALTH
Credentialing Violation
Hotline
215-988-1413
Credentialing and
Re-Credentialing Inquired
1-866-227-2186
AMERIHEALTH
Healthy Lifestyles
1-800-275-2583
AMERIHEALTH
Dental Services
Administered by
Dental Quest
1-800-341-8478
Interactive Voice Response
(IVR) System
1-800-275-2583
NAVINET
Customer Care
(Technical Issues)
1-888-482-8057
NAVINET
Portal Registration
and Questions
1-856-638-2701
https://navinet.navimedix.com
EDI Technical
Support Unit
1-877-234-4271
EMDEON
Provider Support Line
1-800-845-6592
AMERIHEALTH
Transportation Unit
AMERIHEALTH MERCY
Fraud & Abuse Hotline
1-866-833-9718
AMERIHEALTH
Medical Assistance
Transportation Program
(MATP)
1-800-521-6007
(This program is not for Emergencies)
AMERIHEALTH
Family Planning Services
1-800-521-6007
Fax # 1-215-241-9945
AMERIHELATH
Mercy Health Plan
All Claims
AMERIHEALTH
Mercy Health Plan
Claims Processing Department
P O Box 7118
London, KY 40742
**Please Indicate Resubmitted **
or
**Corrected Claims**
on the Claim Form
AMERIHEALTH
Family Planning Claims
AMERIHELATH
First Family Planning
P O Box 8369
Philadelphia, PA 19101-8369
AMERIHEALTH
Provider
Disputes
(Informed)
AMERIHEALTH
Mercy Health Plan
Provider Disputes
2404 Park Drive
Harrisburg, PA 17110
AMERIHEALTH
Mercy Health Plan
Provider
Appeals
(Formal)
AMERIHEALTH
Mercy Health Plan
Provider Appeals
P O Box 7307
London, KY 40742
AMERIHEALTH Mailing Address
North Jersey
485 Route 1 South, 3rd floor
Building C
Iselin, NJ 08830
|
Case Management
& Coordination
(formerly Patient Care Management)
HMO/PPO
Medicare Advantage
&
Commercial
800-313-8628
or
856-778-6374
AMERIHEALTH
Care Coordination
Fax# 1-866-755-0030
AMERIHEALTH
Concurrent Review
Fax # 1-866-755-9936
AMERIHEALTH
Prior Authorization Services
Telephone #: 1-800-521-6622
Fax #: 1-866-755-9949
AMERIHEALTH
Intensive Case
Management Department
1-800-521-6007
AMERIHEALTH
Nurse Call Line
1-866-566-1513
(24 hrs a day 7 days a week)
AMERIHEALTH
Outpatient Radiology
Services
Call for CT/CTA, MRI/MRA, PET,
and Nuclear Cardiology
Precertification Requests
(AIM)
American
Imagining
Management
1-800-859-5288
AMERIHEALTH
Baby Foot Steps
Maternity Care Management
Nurse on call 24 hours a day
1-800-598-BABY
AMERIHEALTH
Laboratory Services
Must be Rendered
@
Quest Diagnostics
1-800-521-6007
http://www.questdiagnostics.com/
OR
Lab Corp
https://www.labcorp.com/
AMERIHEALTH
DME
Prior
Authorization Services
717-651-3465
Fax : 1-215-241-9945
Must Contact
AMERIHEALTH for
Capitated Site
Depends
on Patient Contract
1-800-375-2583
Baby Foot Steps
Prenatal Case Management
Nurse on Call 24 hours a day
800-598-BABY
Mental Health/
Substance Abuse
Magellan Behavioral
Health Members Services
Pre-certification
800-809-9954
http://www.magellanhealth.com
Future Scripts
Prescription Drug
Pre-Authorization
888-678-7012
Fax # 888-671-5285
Mon – Fri: 9:00 am-5 p.m.
Direct Ship Injectables
1-888-678-7012
Future Scripts Secure
Medicare Part D
Prescription
Drug Pre Authorization
1-888-678-7015
Mon – Fri: 8 a.m. -5:pm
Blood glucose meter Hotline
1-888-678-7012
Pharmacy Appeals
1-888-494-8213
Connections Health
Management Programs
call for Disease
Management
and Decision Support
Connections Health
Management Program
1-866-866-4694
Connections Accordant
Care Program
1-866-398-8761
|
Atlanticare Health Plan
|
1-800-272-5995
http://www.atlanticare.org/
|
1-800-272-5995
http://www.atlanticare.org/
|
Cigna HealthCare
Cigna
Provider/ Facility ID#
221775306
www.cigna.com
|
Cigna HealthCare
Nationwide Customer Care
1-800-244-6224
(24 hours/day & 7 days/week)
Cigna Member
Lost ID Card
1-800-244-6224
Cigna Tel-Drug
Pharmacy
1-800-835-3784
Tel-Drug IVR
1-800-835-3784
Pharmacy
1-800-844-6224
Cigna Technical Assistance
Regarding Cigna Website
1-800-261-6232
Cigna HealthCare
Behavioral Health
Claims Address
Cigna Behavioral Health
P O Box 188022
Chattanooga, TN 37422
|
CIGNA
Medical Management
Precertification,
Prior Authorization
1-800-882-4462
Cigna Healthcare
All Medical Appeals
Claims Address:
Cigna Healthcare Inc
National Appeals Unit
P O Box 5225
Scranton Pa, 18505.
CIGNA Behavioral Health
1-800-926-2273
Cigna HealthCare
Ortho Net
(Physical & Occupational Therapy)
Services
1-866-874-0727
|
Empire Blue Cross/
Well Choice
Empire Blue Cross
Facility Provider ID #
310119
&
221775306
www.empireblue.com
|
Empire Blue Cross
New Jersey Provider
Relations Representative
Maria PAWLIK
718-312-4018
Empire Provider
Service
1-800-552-6630
1-800-992-2583
Monday-Friday
8:30am – 5:00 pm
www.empireblue.com
Empire Manage Care
Provider Services
1-800-992-BLUE
1-800-992-2583
Empire Blue Cross
Blue Card
(For out of Area Members Only)
Claim Status/Review:
1-800-713-4173
Eligibility
1-800-676-Blue
(1-800-676-2583)
8:30 a.m. to 5:00 p.m.
Monday thru Friday
Empire Blue Cross
FEP Eligibility
1-800-552-6630
Monday-Friday
8:30 a.m. – 5:00 p.m.
Empire Blue Cross/Well Choice
Fast Check
888-476-7245
FAX # 518-367-3101
Empire Managed Care
Referral Form
Fax No. 1-800-522-5793
Empire Claim Submission
Electronic Commerce Services
1-866-889-7322
Empire HMO/POS Members
1-800-441-2411
Empire EPO/PPO Members
1-800-845-4741
|
Empire Medical Management
Case Management
Department
Empire Medical
Management
Program
HMO
Direct HMO
POS Plans
800-441-2411
Fax:1-800-241-5308
Empire Medical
Management
Program
EPO/PPO Plans
1-800-845-4741
Fax # 1-800-241-5308
Empire Medical
Management
EPO & PPO
800-982-8089
Empire Medical (FEP) Employees
Management Preauthorization
&
Referral Requirements
Via Fax: 1-518-367-4957
Via mail:
Empire Federal
Employee program
PO Box 3876
Church Street Station
New York, NY 10008-3876
Empire (FEP) Employees
Chiropractic Care
&
Physical Therapy
FEP Dedicated Service Center
1-800-522-5566
8:30 a.m. 5:00 p.m.
Monday-Friday
Empire Blue Card
Utilization Review
1-800-713-4173
8:30 am. – 5:00 p.m.
American Imagining
Management
1-877-430-22
Fax # 773-864-4601
(CT, PET, Nuclear Radiology)
www.americanimaging.net
Monday thru Friday
8:00 a.m.-5:00pm
Empire Maternity Care
(For PCP’s and OB/GYN’s)
Empire Medical
Management
1-800-845-4742
Empire
Discharge Summary
(LAD Report)
1-800-426-7844
Nurse Call Center
after 5pm nights,
Weekends, and Holidays
1-800-426-7844
Option 9
Fax # 1-518-367-5362
Behavioral Health
&
Substance Abuse Services
Management
Program
HMO Members
1-800-635-6626
8:30a.m.to 5:00pm
Monday-Friday
www.magellanhealth.com/mbh/index.htm
Behavioral
Healthcare
Management
Program
Child Health
1-800-635-6626
Behavioral Health
&
Substance Abuse Services
Management Program
POS, EPO, or PPO Members
1-800-626-3643
8:30a.m.-5 p.m.
Monday – Friday
www.magellanhealth.com/mbh/index.htm
Empire Fax
Precertification Request
to Ortho Net
For Physical/Occupational/
Speech/Therapies
1-866-800-7485
Empire Manage
Vision Care
888-393-2583
Empire Pharmacy
Management
Caremark
800-839-8442
|
*** Health Net ***
(Formerly Physician
Health Services (PHS)
Health Net
Medicaid Purchased
Brought by AMERICHOICE
Health Net
Commercial Purchased
Brought by United HealthCare
|
Health Net
Provider Services
Department
800-438-7886
Hospital Senior
Provider Representative
Michael Cook
732-353-7459
Physician Representative
Stephanie Vonelli
732-353-7328
Eligibility/Co payment
Verification
800-622-7708
Electronic Claim
Submission
Emden
(Web MD)
877-469-3263
Carrier Code #06108
Healthnet.com
Technical Support
Website Technical
or Navigation Assistance
passwords resets,
locked accounts,
or other site functionality
(8:00 a.m. to 6:00 pm)
(Monday- Friday)
1-888-747-7054
Fraud Hotline
1-800-747-0877
Division of Medical
Assistance
and Health Services
(DMAHS)
Medicaid (NJ only)
1-800-356-1561
Prescription Questions
Caremark Customer Service
1-877-747-9578
(24 hours a day, 365 days per year)
Pharmacy
Provider Requested Prior
Authorization for a Drug
Health Net
Pharmaceutical
Services
Fax # 1-800-977-8226
|
Health Net
Prior Authorization
1800-438-7886
Fax: (888) 747-5747
Health Net
Appeals & Grievances
Telephone
888-747-8494
Fax Clinical
(203) 225-4159
Fax Administrative
(203) 225-4151
Medicare
Fax #
(203) 225-4022
Laboratory Services
Quest Diagnostics
888-631-1390
Facility Locator
800-225-7483
Specimen Pick – Up
800-223-0570
Radiology Service
Care Core National
1-866-889-8059
1-866-898-6287
1-866-469-8989
MHN
Mental & Behavioral
Health Services
1-800-327-2133
www.mhn.com
Health Net Pharmacy
1-866-392-6058
1-800-977-8226 (fax)
Landmark Healthcare
(CT, NJ, and NY)
Chiropractic
&
Acupuncture
1-800-638-4557
1-800-599-8350
Durable Medical
Equipment (DME) Service
April Healthcare
800-294-2275
Ortho Net
(CT, NJ, and NY)
Physical Therapy
and
Occupational Therapy
1-800-413-8695
|
Horizon Blue Cross
&Blue Shield
(PPO/POS/HMO/Indemnity)
Horizon
Blue Cross
&
Blue Shield
Provider/Facility ID #
310119
Horizon Blue Cross Website
www.HorizonBlue.com
|
Horizon Blue Cross
Provider
Relations Department
1-888-666-2535
Hilary Bodnar
New Jersey Hospital
Provider Representative
Senior Hospital
Relation Representative
973-466-5498
Tom McQuade
Hospital Account Executive
Network Hospital Relations
973-466-5286
Fax: 732-938-1472
Cell: 862-588-6343
tom_mcquade@horizonblue.com
Denise Sparrow
Contract Reimbursement
Analyst
973-466-5865
Horizon Blue Cross
Clinical Trials for Blood
& Bone Marrow
1-800-225-2268
Horizon Blue Cross
EDI eService
Desk Contact Information
Email:
HorizonEDI@HorizonBlue.com
Phone # 1--888-334-9242
Fax # 973-466-4319
Fax Server # 973-274-4353
Horizon Blue Cross
PREFIX
YHC, YHI, YHJ, YHK,
YHS, YHU, JGA, JGD, JGG
1-800-624-1110
Claims Address
PO Box 1609
Newark, NJ 07101-1609
Appeals
&
Predetermination
P O Box 10129
Newark, NJ 07101-3129
Horizon Blue Cross
PREFIX
FMA,
FMR, NCH, YHF,
YHN, HIF, HSG, HWA, HWW
and all other National Accounts
1-800-624-4758
Claims Address
PO
Box 247
Newark, NJ 07101-0247
Horizon Blue Cross
PREFIX
HSE, NFW, YHD, YHG,
YHM, YHP, YHT, YHV,
and all other
Point of Service Members
1-800-351-1110
Claims Address
PO
Box 820
Newark, NJ 07101-0820
Appeals/Predetermination Address
PO Box 10129
Newark, NJ 07101-3129
Horizon Blue Cross
Prefix
ATT, AT&T
Members
1-800-624-1110
Claims Address:
P O Box 728
Newark, NJ 07101-0728
Appeals/ Predetermination Address
P O Box 54
Newark, NJ 07101-0054
Horizon Blue Cross
Prefix
JGE,JGB,JGJ,YHO, YHX
Direct Access Members
1-800-624-1110
Claims Address
PO Box 1609
Newark, NJ 07101-1609
Appeals/Predetermination Address
PO Box 10129
Newark, NJ 07101-3129
General Motors/Delphi
Auto
Prefix
(DEH, DTP, DMM, NGM)
1-800-452-9336
Claim Address:
Horizon BCBSNJ
PO Box 639
Newark, NJ 07101-0639
Horizon BCBSNJ
Federal Employees
R- Followed by
8-digits
1-800-624-5078
Claim Submission
Horizon BCBSNJ
PO Box 656
Newark, NJ 07101-0656
Horizon BCBSNJ
IBM Employees
1-732-256-5200
Provider Portal- Contact Information
1-888-777-5075
Provider_Portal@horizonblue.com
Horizon Health
&
Wellness Education Program
(Disease Management Program)
1-888-333-9617
Claims Address
3 Penn Plaza East, PP-13X
Newark, NJ 07101-1740
Horizon Blue Cross
Blue Card Benefits
1-800-676-2583
Horizon Blue Cross
Blue Card
Medical Records
Fax : 973-274-4017
Blue Card Dedicated Unit
1-888-435-4383
or 1-888-666-2535
All Blue Card (out–of-state) claims
Blue Card Service Team
1-800-624-4758
Or
1-888-666-2535
Claim Submission
PO Box 1301
Neptune, NJ 07754-1301
|
Prior Authorization
1-800-664-BLUE
(2583)or for HMO/POS
UM After Hours (after 5pm)
888-223-3072
Press #1 If Provider
Press #2 If member
Horizon Utilization
Management
Out State Out If Network
(8am-6pm)
after 6pm you may leave
a Voice Mail
Facility Number
888-621-5894
Horizon Utilization
Management
Fax #’s
Clinical Management
Unit Fax
Request for Authorizations
should be sent to this number
1-800-492-2580
Home Services Fax
1-800-492-2580
ICM Fax NOA North
1-888-276-5928
ICM Fax NOA South
1-888-224-+7580
ICM Fax Weekend
Concurrent Review
Clinical Information is
Faxed to
Horizon after 2pm
Friday, Saturday and Sunday
888-435-4350
Physical Therapy Fax
Information sent to this
number must have the
therapy fax request form
as the coversheet.
1-800-723-5188
Federal Employee
Program
(FEP)
1-800-624-5078
Horizon Blue Cross FEP
Provider Fax Inquiry Form
1-973-274-4071
Horizon BCBSNJ Blue Card
(Out of State )
For Members with another
Blue Plan Member ship
Horizon BCBSNJ
Blue Card Claims
P O Box 1301
Neptune, NJ 07754-1301
1-888-435-4383
Member Contact
Care
Core National
For Scheduling Assistance
(CCN)
1-866-969-1234
http://www.carecorenational.com
General Motors Prefix
(DEH, DMM, DTP, NGM)
1-800-932-3203 & 3204
Local 835
& Local 108
973-921-1661
CNN
Care Core National
1-866-496-6200
Monday thru Friday
7 a.m. thru 7 p.m.
Saturday & Sunday
9 a.m. thru 5 p.m.
www.CareCoreNational.com
Mental Health or
Substance Abuse
(Magellan Behavioral)
1-800-626-2212
https://www.magellanprovider.com
Physical Therapy
1-888-789-3457
Medicare Blue, HMO, POS,
Direct Access,
or New Jersey Plus Press #1
Physical Therapy
Department Dedicated Fax Lines
Status of post-surgical requests
(for new patients only)
Fax # 1-973-274-2253
Pediatric patients requests
(for patients age 18 and younger)
1-973-274-4037
Home Care Requests
for Physical Therapy
&
Occupational Therapy
1-973-274-4284
Horizon Utilization Management
Appeals
(888) 221-6392- Northern Region
(888) 645-5533- Southern Region
Out State out if Network
Facility Number
888-621-5894
|
Horizon NJ Health
(Formerly Horizon Mercy)
Horizon NJ Health Facility
Provider Identification #
Inpatient – 49056
Out Patient – 1018862
Ancillary – 1015752
Same Day Surgery – 1015753
Emergency - 1015754
Horizon NJ Health
Website Address
http://horizonnjhealth.com |
Horizon NJ Health
Provider Relations
1-800-682-9090
Ian Katz
Hospital Account Executive
Telephone: 609-718-9421
Fax: 609-583-3004
Email: Ian_ Katz @Horizon NJ Health.com
Hospital Relations Representative
Loveann Cranshaw
609-718-9082
Fax: 609-583-3004
Horizon NJ State Health Benefits
Coordinator
1-800-701-0710
Health & Wellness Center
800-682-9094
Member Enrollment
800-637-2997
Member Services
1-877-765-4325
npatient Rehabilitation
1-800-682-9094 Ext. 5104
Horizon NJ
Health Medical Director
800-682-9094 Ext. 5181
Horizon NJ Health
Physician & Health
Care Hotline
1-800-682-9091
24 hours a day,
7 days a week
Family Planning
1-800-833-3344
Mom’s GEMS
Prenatal Program
1-800-682-9094
Newborn
Enrollment Contact
County Board
of Social Services
and Health Benefits
Coordinator
1-800-701-0710
CHAMPS
Preventive Health
and Wellness
Program for Children
& Adolescents
1-800-682-9094
Member Non - Compliance
1-877-765-4325
24 hrs, 7 days a week
Horizon NJ Health
Members
Administrative Appeal
Attn:
Appeals Unit
210 Sylvia Street
West Trenton, NJ 08623
Horizon NJ Health Address:
210 Silvia Street
West Trenton, NJ 08628
|
Horizon NJ Health
Utilization Management Department
1-800-682-9094
Pre-Certification Forms
Can be Faxed
609-538-0829
Care Coordination Unit
1-800-682-9094
(Prompt # 2)
Fax# 609-538-0932
Laboratory Services
Must be Rendered
Lab Corp
800-845-6167
https://www.labcorp.com
Radiology Services
NIA (UM)
1-800-642-7299
www.1.radmd.com
Pharmacy Department
800-682-9094 Ext 5452
Horizon NJ Health
Care Dental Services
1-800-632-3629
Magellan Behavioral Health
1-877-695-5612
Lab Corp Customer Service
1-800-631-5250
Social Services Department
1-800682-9094
Ext 5192
Verbal Appeals Hotline
800-682-9094 Ext. 5606
|
Oxford Health Plans
Oxford
Health Plans
Facility
Provider Identification #
Ho4515
& 221775306
www.oxfordhealth.com
|
Oxford
Provider Services
1-800-444-6222
or
1-800-666-1353
(Mon-Fri, 8:00am-6:00pm)
Oxford On – Call
Oxford Member 24 Hr a Day
1-800-201-4944
EDI Claims:
Oxford Payer ID 06111
Electronic Solutions Support
1-800-599-4334
Fraud Hotline
1-800-915-1909
Fraud Hotline
Medicare Part D (only)
1-877-637-5595
Oxford Members
(Out-of Pocket Costs)
Information Regarding
Emergency Room,
or inpatient Out-of-Pocket Costs<
Physician Services
@
1-800-666-1353
Pharmacy Customer Service
(Commercial Members)
1-800-905-0201
Pharmacy Customer
Service
(Medicare Members)
1-800-711-4555
Oxford Information on Submitting
Electronic Claims,
Please Contact
Physician eSolutions
Support Team
1-800-599-4334
Oxford Claims Submission:
If mailing an Initial Paper Claim
using the CMS-1500
or UB-04 Form
please send the claims:
to the appropriate address
Below within 90 days of
rendering services
Oxford Claims Address
Paper Claims
(Commercial & Medicare Claims)
Oxford Claims
P.O. Box 7082
Bridgeport, CT 06601-7082
Montefiore – CMO Claims
Physicians
or other Health Care Professionals
Participating in a delegated
Risk Agreement for
Medicare in Bronx County
Should Submit Claims TO:
Contract Management
Organizations, LLC
Attn: Claims Department
200 Corporate Drive
Yonkers, NY 10701
Centers for Disease Control
&
Prevention (CDC)
National AIDS Hotline:
1-800-232-4636
Connecticut Info line:
1-800-203-1234
Oxford Members
For Non-English
Speaking Members
Translator Assistance:
In
Chinese, Mandarin, Cantonese,
and Korean
1-800-303-6719
In English and other Languages:
1-800-444-6222
Oxford Members
Hearing - Impaired
New Jersey Department of
Human Services
Division of the Deaf & Hard of Hearing
609-984-7281
New York Society For the Deaf
212-777-3900
New York City Metro Registry of
Interpreters for the Deaf:
212-821-9588
Deaf and Hard of Hearing
Interpreting Services, Inc.
1-718-433-1092
|
Oxford Medical Management
1-800-666-1353
(Mon-Fri, 8:00am-6:00pm)
To Obtain Access
to submit a Precertification
Request
1-800-811-0881
Oxford Behavioral
Health Department
(Precertification Only)
1-800-201-6991
Fax: 1-800-760-4041
Clinical Appeals Department
Fax: 1-203459-7351
Complementary
&
Alternative Medicine
Fax: 1-800-201-7025
Laboratory Information
Laboratory
Corporation of America
(LABCORP)
Patient Service Center Locator
800-845-6167
https://www.labcorp.com
Medicare Appeals
Department
Fax: 1-866-950-5156
Pharmacy Notification
(Commercial Members)
available 24 hours per days,
Seven days per week
Including Holidays
1-800-753-2851
Pharmacy Precertification
(Medicare Members)
1-800-711-4555
Physical and
Occupational Therapy
OptumHealth
(Commercial Members)
Claims Inquiry: 1-877-369-7564
Precertification by Fax: 1-866-695-6923
Claims & Payment inquiry: 1-800-666-1353
Optumhealth Care Solutions
P.O. Box 5800
Kingston, NY 12402-5800
Radiology Information
Care Core National LLC
(Commercial & Medicare Radiology)
1-877-773-2884
www.carecorenational.com
Oxford Disease & Intensive
Case Management Programs:
Active Care Engagement (ACE)
1-877-759-3059
Better Breathing (asthma) 1-800-665-4686
Chronic Obstructive Pulmonary
Disease (COPD) Program
1-800-665-4686
Depression Program: 1-800-665-4686
Heart Smart Programs:
Cardiovascular Disease1-800-665-4686
Heart Failure: 1-800-665-4686
Living with Diabetes:
1-800-665-4686
Oxford Cancer Support Program:
1-800-835-8021
Rare Chronic Care Program:
1-866-217-2921
Transplant Program:
1-888-201-4257
Center for Disease Control
& Prevention (CDC)
National AIDS Testing Programs:
New
Jersey: 1-800-624-2377
Available 24 hours, seven days a week
This Number is only
Accessible when Calling From
New Jersey
New York State
&
New York City Information:
1-800-541-2437
New York State
Spanish/Bilingual Information:
1-800-223-7432
New York State TTY/TDD
(for the hearing –impaired)
1-800-369-2437
New York City Department of
Health Testing Hotline
1-800-825-5448
|
Coventry Healthcare
(Formerly)
Principal
Health Care of Delaware, Inc.
|
1-800-833-7423
|
1-800-833-7423
|
QUALCARE
QUALCARE
PROVIDER
FACILTIY
Identification #
221775306
info@qualcareinc.com
|
Hospital Provider Representative
Eileen McCoy
732-562-2827
QUALCARE Provider Relations
Department
1-800-992-6613
or 1-732-562-0833
QUALCARE
Worker’s Compensation
Network
800-425-3222
GHI Provider
Relations
800-471-2033
QUALCARE
Address:
30 Knightsbridge Road
Piscataway, NJ 08854-3754
|
Utilization Management
QUALCARE
PPO
800-992-6613
QUALCARE
HMO/POS
800-254-0130
QUALCARE
Precertification
Fax Number:
1-732-562-1023
Nurse Advice Line
1-800-622-9529
|
United Healthcare
of New Jersey
United Healthcare
Facility/Provider
Identification #
221775306
|
Provider Services Department
1-800-638-8075
&
1-877-842-3210
|
United Healthcare Care Coordinator Department
1-800-638-7388
&
800-638-3323
|
*** University Health Plans ***
University Health Plans
No Longer
is Providing Services
for NJ’s Family Care
Medicaid Program
as of 12/31/2010
UHP Has
Disconnected Their Phones
For Dates of Services
Prior to 3/1/2010
you will need
to mail your concerns to :
University Health Plans
P.O. Box 3004
Farmington, MO 63640
For Dates of Services
After 3/1/2010
Please Contact
the Member’s Current HMO |
Provider Services Department
1-800-780-2438 option 4
Hospital Provider
Representative
Leona Galloway
732-476-7048
Centene Edi Department
1-800-225-2573 or
email @ EDI@centene.com
Member Services
1-800-564-6847
TDD
1-800-414-7592
|
Medical
Management/Care Management
Prior Authorization
1-800-429-4585
Fax # 1-866-518-6036
University Health Plans Phone Lines Disconnected
Pharmacy US Script
Prior Authorization
1-866-399-0928
Pharmacy Script
Solutions
Prior Authorizations/Claims Issues
1-800-555-8513
Fax # 800-583-6010
Vision OptiCare Health Systems
1-866-458-2137
|
WELLCHOICE
Well CHOICE
Provider/Facility #
310119
WellChoice
Website
www.wellchoicenj.com
|
WellChoice
Provider Service Line
1-888-476-7245
Maria PAWLIK
New Jersey
Provider Relations
Representative
1-718-312-4018
PCPs Fax Referral Form to
800-522-5793
or Mail Referral Form to:
WellChoice
PO Box 3509
Church Street Station
New York, NY 1008-3509
(Attn: Referrals)
Electronic Claim Submissions
New Accounts:
212-476-7934/7952
Existing Accounts:
315-449-0080
WellChoice
Claims Submissions
WELLCHOICE
P.O. Box 3509
Church Street Station
New York, NY 10008-3509
Include EHP or Unique Prefix
|
HMO
Medical Management
1-800-441-2411
PPO
Medical Management
1-800-982-8089
Indemnity
Medical Management
1-800-548-0120
WellChoice
Medical
Management Program
WellChoice Baby Care
(for PCPs & Ob/GYNs)
Emergency Drug
Authorizations/Drug Formularies
Pharmacy Management
800-839-8442
Behavioral
Health Care
Management Program
HMO 1-800-635-6626
PPO 1-800-626-3643
Indemnity
1-800-435-8184
|
