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HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY ELECTRONIC TRANSACTION AUTHORIZATION FORM Health Care Professional, Hospital, Facility or Trading Partner Name: ___ Address: ___ City: ___ State: ___ ZIP:
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How to fill out horizon-bcbsnj-3193-authorization-form-edi-electronic
How to fill out horizon-bcbsnj-3193-authorization-form-edi-electronic
01
Obtain the Horizon BCBSNJ 3193 Authorization Form for EDI Electronic.
02
Enter the provider's information including name, address, and contact details.
03
Provide the patient's information such as name, date of birth, and insurance ID number.
04
Specify the services being authorized and the duration of the authorization.
05
Sign and date the form, ensuring all required fields are completed accurately.
06
Submit the completed form to the appropriate party for processing.
Who needs horizon-bcbsnj-3193-authorization-form-edi-electronic?
01
Healthcare providers who wish to authorize electronic transactions with Horizon BCBSNJ.
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What is horizon-bcbsnj-3193-authorization-form-edi-electronic?
The horizon-bcbsnj-3193-authorization-form-edi-electronic is a form used for electronic authorization of services with Horizon BCBSNJ.
Who is required to file horizon-bcbsnj-3193-authorization-form-edi-electronic?
Healthcare providers and facilities are required to file horizon-bcbsnj-3193-authorization-form-edi-electronic when seeking authorization for services with Horizon BCBSNJ.
How to fill out horizon-bcbsnj-3193-authorization-form-edi-electronic?
The horizon-bcbsnj-3193-authorization-form-edi-electronic must be filled out with accurate and complete information regarding the patient, services requested, and provider details.
What is the purpose of horizon-bcbsnj-3193-authorization-form-edi-electronic?
The purpose of horizon-bcbsnj-3193-authorization-form-edi-electronic is to request authorization for healthcare services to be provided by Horizon BCBSNJ.
What information must be reported on horizon-bcbsnj-3193-authorization-form-edi-electronic?
The horizon-bcbsnj-3193-authorization-form-edi-electronic must include patient demographics, service details, provider information, and any other relevant data required for authorization.
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