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Refer Members to our Preferred Labs
Act
immediately
Effective date
Not stated in the notice
Identified
Oct 3, 2026
Summary
Horizon BCBSNJ is requiring providers to refer patients enrolled in managed care plans without out-of-network benefits to preferred labs (Horizon's network labs only, excluding LabCorp or Quest Diagnostics). Providers must direct testing samples to in-network facilities or face potential network termination. This applies to specific managed care plans; providers must verify plan type before ordering labs.
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What to do
immediately · 4 steps
01Billing and clinical teams must (1) obtain the complete list of Horizon BCBSNJ managed care plans that prohibit out-of-network lab benefits from Horizon's provider portal; (2) update referral workflows and lab order forms to route patients on these specific plans to Horizon's preferred in-network labs only; (3) train all ordering providers and front desk staff to verify plan type before authorizing lab orders; (4) implement a verification step in the billing system or EMR to flag and block orders to LabCorp or Quest for restricted plan members.
02Update patient communication materials to direct affected members to preferred labs.
03Failure to comply may result in provider network termination and claim denials.
04Establish a process to check the managed care plan list periodically for updates.
Original notice
Refer Members to our Preferred Labs
horizonblue.com · Always check the source before changing claims.
Related changes
See all Horizon BCBS NJ changes →Use In-Network Labs for Patient ServicesHighNo effective date · NetworkUse Preferred LaboratoriesHighNo effective date · Provider NewsRemember to Use these Labs to Stay CompliantHighNo effective date · Provider NewsRefer Members to our Preferred LabsHighNo effective date · Provider NewsBrowse every Horizon BCBS NJ change in the policy list