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Horizon BCBS NJMedicare Advantage · Coverage · Provider NewsHigh impact

Use Preferred Laboratories

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

Summary

Horizon Blue has implemented a preferred laboratory network requirement for managed care plans without out-of-network benefits. Effective immediately, all testing samples from patients in these plans must be sent to LabCorp or Quest Diagnostics only. Patients in plans with out-of-network benefits may use alternative 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 · 5 steps
01Billing and clinical staff must update laboratory referral workflows to identify which Horizon plans include out-of-network benefits and which do not.
02For patients enrolled in Horizon plans WITHOUT out-of-network benefits, route ALL testing samples exclusively to LabCorp or Quest Diagnostics.
03For plans WITH out-of-network benefits, if an alternative lab is used, ensure the patient has signed an Out-of-Network Consent Form per Horizon's Out-of-Network Consent Policy before submitting the claim.
04Audit team should review claims submitted in the past 3 days to identify any non-compliant laboratory referrals and contact affected patients and providers immediately.
05Add a verification step in the billing system or EMR to flag laboratory selections against the Horizon plan type before claim submission.
If missed: Failure to comply will result in claim denials and potential termination from the Horizon Managed Care Network and Horizon PPO Network.

Original notice

Use Preferred Laboratories
horizonblue.com · Always check the source before changing claims.
View original ↗

Related changes

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