Horizon BCBS NJ Billing Guide for Therapists and Psychiatrists

Horizon BCBS NJ is Horizon Blue Cross Blue Shield of New Jersey, the Blue plan for New Jersey (BCBSA licensee map). This guide shows psychotherapists and psychiatrists how to bill Horizon BCBS NJ: payer ID, claim routing, filing and payment timelines, appeals, credentialing and telehealth. Checked on Horizon's provider site and New Jersey government sites, 10/18/26.

Blue plans are independent companies, so do not apply these rules to another Blue plan. Providers in Maryland and DC can start with the Mid-Atlantic Blue Cross guide.

Private payer rules: how Horizon BCBS NJ wants claims

Submit claims electronically

Horizon says most member claims for all plans can go electronically with Payer ID 22099. Professional providers can also use Availity Essentials: choose the plan in Payer Spaces, then Claims & Payments, then Claims & Encounters. Corrected claims and claims where Horizon is secondary cannot go through Availity Essentials. Send those by EDI through your clearinghouse. Horizon's eBusiness Desk for Availity claim questions is 1-888-777-5075, Monday to Friday, 7 a.m. to 6 p.m.

Filing limit and corrected claims

Horizon's professional provider manual says claims generally must be submitted within 180 days of the date of service. Your contract and plan can differ, so confirm yours. Learn how timely filing works across payers in our glossary.

Credentialing and network status

Behavioral health practitioners, including those who only provide telemedicine, can apply to join Horizon's networks. Horizon offers two ways to apply: its online enrollment tool, or a mailed credentialing checklist and application. Since October 1, 2019, Horizon handles initial credentialing and recredentialing for behavioral health practitioners itself, not through Beacon Health Options. Read our credentialing guide and the in-network versus out-of-network guide before you apply.

Behavioral health authorizations

Horizon's Horizon Behavioral Health page points providers to an online Utilization Management Request Tool, available 24/7, for authorization requests. It also lists a Prior Authorization Procedure Search Tool. Check each member's plan before you schedule, because prior authorization rules vary by plan.

Horizon BCBS NJ telehealth billing

Horizon's Telemedicine and Telehealth Services policy (effective June 1, 2016; revised and reviewed September 24, 2026) applies to participating and non-participating professional providers. These are the billing points that matter for therapy and psychiatry:

• Video visits: add modifier 95 or GT to eligible codes.
• Audio-only visits: add modifier 93 or FQ, and only for services on Horizon's eligible audio-only list.
• Place of service: POS 10 when the member is at home, POS 02 when the member is not at home. See our place of service codes and telehealth codes pages.
• Cost sharing: the same deductible and copay as an in-person visit.
• Audio-only behavioral health: the policy cites New Jersey's telemedicine and telehealth parity law and says these services are reimbursed at a rate equal to the provider reimbursement rate.
• Records: documentation must support the service, and Horizon may run utilization review.

New Jersey state law that affects Horizon claims

State law and private payer rules are different things. These items are New Jersey state law, as Horizon and the state publish them.

• Prompt pay. Horizon's prompt pay page cites N.J.A.C. 11:22-1.5: a payer must pay a clean claim within 30 calendar days if filed electronically, or 40 calendar days if not. Unpaid claims must be denied or disputed in the same window. See the DOBI prompt pay page.
• Claim payment appeals. Horizon's appeals section says written claim appeals go on DOBI's required form within 90 calendar days of the claim payment determination. For fully insured claims, finish Horizon's internal appeal before you ask the state's arbitrator, Maximus, to review it through PICPA.
• Mental health parity. P.L.2019, c.58 requires mental health and substance use coverage on the same terms and conditions as other illness. DOBI enforces it.

Medicare and Medicaid are separate

Medicare and Medicaid follow their own rules, not the commercial rules above. Horizon's provider pages also list Horizon NJ Health and Braven Health, each with its own details. Use CMS.gov for Medicare and confirm Medicaid rules with the plan before billing.

How MCM South helps with Horizon BCBS NJ

MCM South bills Blue plans for psychotherapists and psychiatrists in the states we serve. We verify benefits, submit claims electronically, follow up on denials and appeals, and handle credentialing. Get a free quote.

Horizon BCBS NJ billing FAQ

What is the Horizon BCBS NJ payer ID?

Horizon lists Payer ID 22099 for member claims on all plans, including the Federal Employee Program. Braven Health plans use Payor ID 84367.

How long do I have to file a claim with Horizon BCBS NJ?

Horizon's professional provider manual says claims generally must be submitted within 180 days of the date of service. Check your contract for exceptions.

How long does Horizon have to pay a clean claim?

New Jersey's Prompt Pay Law gives payers 30 calendar days for electronic clean claims and 40 for other claims. Unpaid claims must be denied or disputed in that time.

How do I appeal a Horizon claim payment decision?

File a written appeal on the DOBI form within 90 calendar days of the payment determination. For fully insured claims, finish Horizon's internal appeal before you request state arbitration.

Does Horizon BCBS NJ pay for telehealth therapy?

Yes, under its Telemedicine and Telehealth Services policy. Bill modifier 95 or GT for video, 93 or FQ for audio-only, and POS 10 or 02.

MCM South currently serves practices in GA, MA, CT, TX, FL, NY, CO, TN, NC and IL, and has worked in all 50 states. If your state is not on that list, ask us. This page is operational guidance for billing, not legal advice. For real financial or legal exposure, talk to your attorney or compliance officer.

Related: Blue Cross by State · How Blue Cross Blue Shield Works · Billing Terms Glossary · CPT and E/M Code Guide · Who We Serve.