UH - Managed Care Office

Office of Managed Care Operations

HORIZON/MERCY

	Quick Reference Guide
	Telephone Guide
	Claims Address

HORIZON/MERCY QUICK REFERENCE GUIDE

Facility/Provider #49056 Ancilliary#1015752 Same Day Surgery#1015753
Emergency#1015754

ELECTIVE	REQUIREMENTS
Inpatient Admission	Authorization Required by Admitting Physician
Same Day Surgery	Authorization Required by Admitting Physician
Out Patient Procedure	Authorization Required by Admitting Physician

NOTE: All Elective Inpatient, Same Day Surgery & Out Patient Procedure must be called in by Admitting Physician to obtain authorization @ 1-800-682-9094, Hospital to verify authorization obtained.

NOTE: Horizon HMO is responsible for payment on all claims related to Family Planing Services, including Voluntary Sterilization, Tubal Ligation, Vasectomy, or similar procedures have the purpose of pregnancy prevention contact Family Planning Services @ 800-833-3344 for prior authorization.

NOTE: Horizon/Mercy does not cover for elective/induced abortions under this contract, but will continue to be paid on Fee-For Service (FFS) basics by Medicaid.

EMERGENCY/DIRECT

EMERGENCY ROOM VISIT	No notification or Authorization required: Self Referral
EMERGENCY ADMISSION	24-hr notification required by Hospital to obtain billing reference #
DIRECT ADMISSION	24-hr notification required by Hospital or Physician to obtain billing reference #
MENTAL HEALTH/ADMISSION SUBTANCE ABUSE	See note below
NON EMERGENCY MENTAL HEALTH	See note below

NOTE: Mental Health & Substance Abuse Benefits are not provided by Horizon/Mercy. All services for Mental Health and Substance Abuse is available through the Medicaid Fee-For-Service program. See our Quick Reference Guide.

Horizon/Mercy provides Mental Health & Substance Abuse services to clients of the Division of Developmental Disabilities. This benefit is administered thhrough Magellan Behavioral Health. Providers, and Members who are clients ofthe Division of Developmental Disabilities, may call Magellan Behavioral Health at 887-695-5612.

HORIZON/MERCY

QUICK REFERENCE GUIDE

Referral/Pre-Auth. Requirements for Outpatient Services

REFERRAL REQUIRED-OUT PATIENT

PRE AUTHORIZATION REQUIRED-OUT PATIENT

Specialist Visit

Non-Emergent Ambulance (Transpt)

Ultrasound (Non OB related)

Rehabilitative Therapy

MRI

Radiation Therapy

CT Scan

Infusion Therapy

Nuclear Medicine

Hemodialysis and Renal Therapy

Audiology Services Hearing Aids

Chemotherapy

Radiology Routine

Blood Transfusion

PAT or Stat Hospital Lab

NOTE: Mental Health Services & Chem Depend call Magellan for clients of Division of Developmental Disabilities 1-877-695-5612

PT, OT, ST Thereapies are covered by Medicaid, fee for service.

HORIZON/MERCY
TELEPHONE GUIDE

HORIZON/MERCY ACCOUNT EXECUTIVE JESUS MERCADO, JR.	1-800-689-9094 x6697
HORIZON/MERCY PROVIDER REPRENSENTATIVE, CYNTHIA HARDY	1-800-637-2997 x6673
Horizon/Mercy Provider Services Department	1-800-682-9091
Horizon/Mercy Precert Department	1-800-682-9094
Family Planning Horizon HMO	1-800-833-3344
Member Services Department	1-800-NJ-MERCY
NJ Family Care Member Services	1-800-KID-5656
Lab Corp	1-800-631-5250