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Check Member Out-of-Pocket Cost Share and Prior Authorization Requirements Online
Act
immediately
Effective date
Not stated in the notice
Identified
Oct 3, 2026
Summary
Horizon BCBS New Jersey is introducing a self-service online Eligibility and Benefits Cost Share Estimator tool for members with IDs containing '3HZN'. This tool eliminates the need to call for eligibility verification, cost-share estimates, and prior authorization requirements, and is accessible through NaviNet with diagnosis and CPT/Revenue code-level detail. Billing teams can now obtain prior authorization information and patient cost estimates online rather than through phone calls.
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What to do
immediately · 5 steps
01Billing team and front desk staff should transition from phone-based eligibility and prior authorization verification to the online Cost Share Estimator tool for all Horizon BCBS New Jersey members with member IDs containing '3HZN'.
02Access the tool via NaviNet by clicking the Cost Share Estimator icon on the Horizon BCBS NJ Plan Central page or selecting 'Eligibility and Benefits' > 'Cost Share Estimator' from the workflow menu.
03Retain the reference numbers generated by the tool for claim submission documentation.
04Contact your Network Specialist or Hospital Relations Representative to schedule staff training if needed.
05No immediate deadline applies, but delays in implementation may result in slower eligibility verification and prior authorization processing.
Original notice
Check Member Out-of-Pocket Cost Share and Prior Authorization Requirements Online
horizonblue.com · Always check the source before changing claims.