Investigate a claim online

Health Plans: 

  • Horizon NJ Health

Workflow: 

  • Claim Investigation

Starting October 28 2019, Horizon NJ Health will let you submit questions about a claim online instead of by phone, fax, or mail.

On the Claim Status Details screen, click Investigate to start a new claim investigation or to review and respond to existing investigations.

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Horizon NJ Health allows investigations on finalized claims with a service date up to 18 months in the past. If the claim is in a status other than Finalized, or is older than 18 months, the Investigate link is not available. 

Note: Do not use the Investigate feature to appeal a claim. To appeal a claim, mail your appeal to Horizon NJ Health Claim Appeals, P.O. Box 63000, Newark, NJ 07101, or fax it to 973-522-4678. To check the status of an appeal, call Provider Services at 1-800-682-9091 or access the Claim Appeals Status Report.

For complete details about this feature, see the Claim Investigation User Guide.

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