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Horizon BCBS NJCommercial · Administrative · Provider News · NJHigh impact

Remember to Use these Labs to Stay Compliant

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

Summary

Horizon Blue Cross Blue Shield has mandated that all testing samples for patients enrolled in Horizon managed care plans without out-of-network benefits must be referred exclusively to Labcorp or Quest Diagnostics. Patients with out-of-network benefits may use other labs only if they elect out-of-network coverage and complete required consent forms. Non-compliance may result in network termination.

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What to do

immediately · 8 steps
01Billing and clinical staff must implement the following changes.
02Update laboratory referral protocols in the EHR/practice management system to route all test orders for Horizon managed care patients WITHOUT out-of-network benefits exclusively to Labcorp or Quest Diagnostics.
03For Horizon patients WITH out-of-network benefits who request alternative labs, require providers to obtain and maintain the Out-of-Network Consent Form prior to sending samples.
04Audit current lab referral patterns to identify any non-compliant referrals and contact patients/providers to redirect samples.
05Train front desk, clinical, and billing staff on the new lab routing requirements.
06Maintain complete documentation of all Out-of-Network Consent Forms for Horizon audit purposes.
07Failure to comply will result in claims denial, practice penalties, and potential termination from Horizon networks.
08Horizon will conduct data analysis of claims to identify non-compliance.

Original notice

Remember to Use these Labs to Stay Compliant
horizonblue.com · Always check the source before changing claims.
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