For Dentists

Horizon BCBSNJ Manual for Participating Dental Professionals

Participation in Dental Networks

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Provider Networks

Horizon BCBSNJ Dental Networks:

  • Horizon Traditional
  • Horizon PPO
  • Horizon Dental Choice (HDC)
  • Horizon TotalCare
  • Horizon Plan J
  • Local 1262: This is a need-based non-Horizon BCBSNJ network that is maintained by Horizon BCBSNJ.

Owners of participating locations must participate, at a minimum, in the Horizon Traditional Network.

Credentialing Documentation

To participate in any of our networks, including Local 1262, the following documents are required and constitute a complete credentialing application:

  • Horizon BCBSNJ application
  • Horizon BCBSNJ attestation
  • Agreement with Participating Dentist: For newly credentialed associates at existing participating locations until the effective date of your participating location’s Participating Location Group Dental Agreement. For owners of a new location, a Participating Location Group Dental Agreement is required.
  • Amendment to Agreement with Participating Dentist: For newly credentialed associates at existing participating locations until the effective date of your participating location’s Participating Location Group Dental Agreement.
  • National Grid Amendment: For newly credentialed associates at existing participating locations until the effective date of your participating location’s Participating Location Group Dental Agreement.
  • PLEASE NOTE: After a Participating Location Group Agreement becomes effective for a dental practice, any new associate requesting to be credentialed for participation in Horizon BCBSNJ’s network(s), must be added to the then existing Participating Location Group Agreement for the respective practices where they work. Such associates, therefore, will not receive their own agreements.

Recredentialing Documentation

Dentists who participate in any network that Horizon BCBSNJ administers or maintains must be recredentialed every three years. Horizon BCBSNJ will contact each dentist and provide a recredentialing application. Please review the application for any needed changes and return it with the documents required for credentialing.

If you have any questions or require additional forms, please contact the Professional Relations Representative for your respective county as outlined in the chart.

Change Requests

The Professional Relations Department maintains and updates demographic information for all participating dentists. Please complete the Office/Provider Change Form to notify the Professional Relations Department of any changes in demographic information, including:
  • Addition or removal of a dentist to staff
  • Changes to location or mailing address
  • Changes to Tax ID number

A new Participating Location Group Dental Agreement must be executed if an owner opens a new location.

Please complete the Office/Provider Change Form or send the information on your letterhead with a dentist's signature to:

Horizon BCBSNJ Dental Programs
Attn: Provider File Maintenance
3 Penn Plaza East, PP13Y
Newark, NJ 07105-9874

Requests can also be faxed to 1-973-274-2202.

Form Requests

Forms can be found at HorizonBlue.com/dental. You can also request forms by calling 1-800-4DENTAL (433-6825).

Termination Request

If you wish to terminate your participation in our network(s), please submit your request in writing to:

Horizon BCBSNJ Dental Programs
Attn: Provider File Maintenance
3 Penn Plaza East, PP13Y
Newark, NJ 07105-9874

The terms of the Agreement define your responsibilities for continuation of care if you decide to terminate your participation in our network(s). Termination will be effective according to the terms of the Agreement with Horizon BCBSNJ. Horizon BCBSNJ will acknowledge, in writing, the termination request with the effective date of the termination.

National Provider Identifier (NPI)

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), all health care providers considered “covered entities” under HIPAA no longer need to keep track of and use multiple ID numbers for multiple insurers. Instead, providers must use their National Provider Identifier (NPI) supplied by the Centers for Medicare & Medicaid Services (CMS). A covered entity is any health care provider who transmits health information in electronic form. Such transmissions include electronic claims submissions, either by the provider or by a billing company on the provider’s behalf, transmissions to credit card companies for payment, or the use of the Internet to verify eligibility or checking the status of a claim.

Horizon BCBSNJ strongly encourages all providers to apply for an NPI number. There are two ways to apply for your NPI:

  1. Visit one of the websites below:
    a. nppes.cms.hhs.gov
    a. cms.hhs.govinationalprovidentstand
  2. Call 1-800-465-3203 to request an application.

Please register your NPI with Horizon BCBSNJ as soon as you get your NPI Certification Notice from CMS. To register your NPI, complete the NPI Collection Form and fax it, along with a copy of your NPI Certification Notice from CMS, to 1-973-274-2202. You can also mail the form and notice to:

Horizon BCBSNJ Dental Programs
Attn: Manager, Dental Services
3 Penn Plaza East, PP13Y
Newark, NJ 07105

Reminder:The NPI does not replace your Tax ID number. All claims submitted electronically require both the NPI and Tax ID numbers.

If you are registering your NPI number as part of initial credentialing with Horizon BCBSNJ, please follow the directions in the credentialing documents. The above directions for registering your NPI number with Horizon BCBSNJ only apply to currently participating providers.

Member Identification (ID) Cards

Members enrolled in our dental programs are issued member ID cards. The member ID card contains important information you will need to complete the claim form. We advise members to present their ID card at the time of their visit. If their contract ends for any reason, this card becomes void and they are no longer eligible for Horizon BCBSNJ dental benefits.

You can verify eligibility online or you may call our Customer Service Department at 1-800-4DENTAL (433-6825) for help.

Electronic Fund Transfer (EFT)

Horizon BCBSNJ Dental Programs offers Electronic Funds Transfer (EFT) to offices. By enrolling for EFT payments, your weekly reimbursement for claims will be electronically deposited into your office’s bank account. The deposits will be made on a weekly basis. You will receive a paper Explanation of Benefits for patient account reconciliation.

If you would like to register for EFT, please use the Automated Clearinghouse Authorization Agreement. You may fax the form to 1-877-631-8931 or mail to:

Horizon BCBSNJ Dental Programs
Attn: EFT Department
PO Box 1612
Minneapolis, MN 55440-1612