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Office of Managed Care Operations
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Quick Reference Guide |
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Telephone Guide |
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Claims Address |
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Horizon Blue Cross Blue Shield Website (This link is provided for the convenience of our website visitors. UMDNJ University Hospital takes no responsibility for the information or proprietary of the web sites listed above.) |
Facility/Provider # 310119
| ELECTIVE | REQUIREMENTS |
| INPATIENT ADMISSION | Authorization Required by Admitting Physician, Hospital Verify |
| SAME DAY SURGERY | Referral Required |
| OUT PATIENT PROCEDURE | Referral Required |
NOTE: Admitting Physician must call to obtain authorization @ 1-800-624-1294 (precertification). Hospital Admitting Department must call Federal Blue Cross prior to admission or surgery to make sure admission or surgery has been authorized.
NOTE: Please Call the Precertification Department prior to Elective Same Day Surgery or Outpatient Procedures, some Procedures require authorization.
NOTE: Federal Blue Cross of NJ Point of Service does not cover Elective Abortion.
| EMERGENCY ROOM VISIT | No Authorization required. Patient or PCP must notify FederalBlue Cross-of ER visits. |
| EMERGENCY ADMISSION | Authorization required (24-hr or next business day notification required by Hospital) |
| DIRECT ADMISSION | Authorization required (24-hr or next business day notification by Admitting Physician hospital verify) |
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MENTAL HEALTH/ADMISSION SUBSTANCE ABUSE |
See note below |
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NON EMERGENCY MENTAL HEALTH & SUBSTANCE ABUSE |
See note below |
NOTE: Mental Health & Substance Abuse Admission Please notify Magellan Behavioral Health of NJ @ 1-800-626-2212.
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REFERRAL REQUIRED-OUTPATIENT |
PRE AUTHORIZATION REQUIRED –OUTPATIENT |
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NOTE: Mental Health & Chem Depend must call Magellan Behavioral Health@ 1-800-626-2212 Prior to services.
NOTE: For Audiology Service & Laboratory Services please contact Provider Service @ 1-800-664-2583
Facility/Provider # 310119
| ELECTIVE | REQUIREMENTS |
| INPATIENT ADMISSION | Authorization Required by Admitting Physician, Hospital Verify |
| SAME DAY SURGERY | Referral Required |
| OUT PATIENT PROCEDURE |
Referral Required |
| OUT PATIENT CLINIC VISIT | Clinic visit are an excluded services fir University Hospital, Blue Cross does not pay University Hospital facility fee for clinic visits; Blue Cross pays Physicians for enrolled patients. |
| EMERGENCY ROOM VISIT | No Authorization required. Patient must notify Blue Choice or NJ Plus within 48-hrs. |
| EMERGENCY ADMISSION | Authorization required (24-hr or next business day notification required by Hospital) |
| DIRECT ADMISSION | Authorization required (24-hr or next business day notification by Admitting Physician, Hospital verify) |
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MENTAL HEALTH/ADMISSION SUBSTANCE ABUSE |
See note below |
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NON EMERGENCY MENTAL HEALTH SUBSTANCE ABUSE |
See note below |
Note: Mental Health & Substance Abuse Admission please notify Magellan Behavioral Health @ 1-800-626-2212.
Facility/Provider # 310119
| ELECTIVE | REQUIREMENT |
| INPATIENT ADMISSION | Authorization Required by Admitting Physician, Hospital Verify |
| SAME DAY SURGERY | Referral Required |
| OUT PATIENT PROCEDURE | Referral Required |
| OUT PATIENT CLINIC VISIT | Outpatient Clinic Visit are excluded services for University Hospital, Medicare Blue & HMO Bluedoes not pay for clinic visit: HMO Blue & Medicare Blue pays Physicians for enrolled patients. |
| NOTE: Admitting Physician must call to obtain authorization @ 1-800-624-1294 (precertification). Hospital Admitting Department must call HMO Blue & Medicare prior to admission or surgery to make sure admission or surgery has been authorized. | |
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| NOTE: All OB/GYN High Risk Pregnancy requires authorization for Elective Surgery. | |
| EMERGENCY ROOM VISIT | No Authorization required. PCP, Patient or Hospital must notify HMO Blue & Medicare Blue of ER Visit within 48 hours |
| EMERGENCY ADMISSION | Authorization required (24-hr or next business day notification required by Hospital) |
| DIRECT ADMISSION | Authorization required (24-hr or next business day notification by Admitting Physician) |
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MENTAL HEALTH/ADMISSION SUBSTANCE ABUSE |
See note below |
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NON EMERGENCY MENTAL HEALTH & SUBSTANCE ABUSE |
See note below |
NOTE: Mental Health & Substance Abuse Admission, please notify Magillan Behavioral Health@ 1-800-626-2212.
Facility/Provider # 310119
| ELECTIVE | REQUIREMENTS |
| INPATIENT ADMISSION | Authorization Required by Admitting Physician, Hospital Verify |
| SAME DAY SURGERY | Referral Required |
| OUT PATIENT PROCEDURE | Referral Required |
NOTE: Admitting Physician must call to obtain authorization @ 1-800-624-1294 (precertification). Hospital Admitting Department must call AT&T & Lucent Technologies prior to admission or surgery to make sure admission or surgery has been authorized.
NOTE: Please call the Precertification Department prior to Elective Same Day Surgery or Procedures, some procedures require authorization.
| EMERGENCY ROOM VISIT | 24-hr notification required by Patient, PCP or Hospital to obtain authorization # |
| EMERGENCY ADMISSION | Authorization required (24-hr notification required by Hospital) |
| DIRECT ADMISSION | Authorization required (24-hr notification required by PCP or Hospital) |
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MENTAL HEALTH/ADMISSION SUBSTANCE ABUSE |
See note below |
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NON EMERGENCY MENTAL HEALTH & SUBSTANCE ABUSE |
See note below |
NOTE: Mental Health & Substance Abuse Admission, please notify ATT Mental Health @ 1-800-695-0090
| PROVIDER REPRESENTATIVE, John Thorton |
(973) 466-7522 |
| Horizon Blue Cross & Blue Shield (HMO & POS) Provide Relations & Precert Department. | 1-800-664-2583 |
| Horizon BCBSNJ | (973) 466-4000 |
| NGM-General Motors | 1-800-452-9336 |
| Horizon Provider Inquiry | 1-800-624-4758 |
| Horizon Healthcare Administrators | 1-888-328-2287 |
| Insurance Design Administrators (IDA) | 1-800-225-1345 |
| Blue Card Eligibility Line Out-of-State BCBS Subscribers |
1-800-676-BLUE |
| Enrollment, Benefits, Claims Federal Employee Plans All Other Plans |
1-888-666-2535 1-800-624-5078 |
| Care Advanage PPO/Indemnity Precert Federal Plan Precert |
1-800-624-1294 |
| Avaya Mental/Nervous Services | 1-877-804-9753 |
| Local 1262 Mental/Nervous Services | 1-800-843-5503 |
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Local 164 Enrollment, benefits, Claims |
1-201-225-1641 1-877-543-1024 |
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(all information subject to change without notice) |
Last Reviewed: October 2008
All contents copyright © 1997-8
UMDNJ. All rights reserved
All information within this site subject to change without notice.
University Hospital
150 Bergen Street
Newark, NJ 07103 USA
(973) 972 - 4300