How does this apply if the member wants to use a radiology facility outside of NJ?
For facilities within the contiguous counties (DE, PA or NY), if that site is participating with Horizon, they will need to get prior authorization from CCN (for member contracts that require prior authorization). If the rendering site is not participating with Horizon, they do not need to have prior authorization as the claims will process against the members Out of Network benefits (if applicable) or will be processed by Bluecard (ITS local plan).
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- How does this apply if the member wants to use a radiology facility outside of NJ?
