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Horizon BCBS NJAll Plans · Administrative · Provider News · NJHigh impact

Submit UM Appeals in Availity Essentials™

Act
immediately
Effective date
Not stated in the notice
Identified
Oct 3, 2026

Summary

Horizon Blue is mandating electronic submission of Utilization Management (UM) appeals through Availity Essentials portal instead of mail. Billing teams must transition all appeal submissions to the online portal and ensure third-party vendors are also submitting electronically to reduce delays and enable real-time status tracking.

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What to do

immediately · 5 steps
01Billing team must establish Availity Essentials as the primary submission method for all UM appeals.
02Audit and notify all third-party appeal vendors (if applicable) to transition to electronic submission through Availity.
03Update internal appeal submission procedures and staff training to reflect the portal-first requirement.
04Remove mail-based appeal submission from standard workflows.
05Monitor appeals submitted after policy publication via the Availity tracking system instead of phone calls to verify processing status.
If missed: Failure to comply may result in appeal processing delays and denials due to mail routing issues.

Original notice

Submit UM Appeals in Availity Essentials™
horizonblue.com · Always check the source before changing claims.
View original ↗

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