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For Dentists

Horizon BCBSNJ Manual for Participating Dental Professionals

Dental Utilization Management Appeals Process

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Members/covered persons (hereinafter referred to as ”members“), dentists or authorized representatives acting on behalf of the member and with the member's written consent generally have the right to pursue an appeal of any adverse utilization management decision made by Horizon BCBSNJ. An adverse utilization management decision is a decision to deny or limit a service or procedure based on Horizon BCBSNJ’s clinical and dental necessity criteria.

First Level

If you disagree with our decision, you have 180 days following your receipt of our determination letter to request a dental appeal. If you wish to make a first-level dental appeal, you may do so by sending your appeal in writing to:

Horizon BCBSNJ Dental Programs
Dental Appeals & Complaints
PO Box 551
Minneapolis, MN 55540-0551

Second Level

If you disagree with our first-level dental appeal decision, you have 180 days following receipt of our original determination to request a second-level dental appeal. If you wish to make a second-level dental appeal, you may do so by sending your appeal in writing to:

Horizon BCBSNJ Dental Programs
Dental Appeals & Complaints
Attention: 2nd Level Appeals
PO Box 551
Minneapolis, MN 55540-0551