Horizon Medicare Prescription Drug Plans

For Pharmacists

Horizon Blue Cross Blue Shield of New Jersey Payer Sheet Information for Medicare Part D
Marketing Names	MAPD: Horizon Medicare Blue Value w/ Rx Standard Horizon Medicare Blue Value w/ Rx Enhanced Horizon Medicare Blue Value w/ Rx Plus Horizon Medicare Blue Access w/ Rx Standard Horizon Medicare Blue Access w/ Rx Enhanced Horizon Medicare Blue Access w/ Rx Plus PDP: Horizon Medicare Blue Rx Standard Horizon Medicare Blue Rx Enhanced Horizon Medicare Blue Rx Plus
Region	New Jersey
RXBIN	004336
RXPCN	HZRX
RXGRP	RX7098 RX7099 RX7100 RX7101 RX7104 RX7105
Secondary Information*	RXBIN: 012114 RXPCN: COBSEGADV
Phone Numbers (pre- and post-enrollment)	PDP and MAPD Pre-enrollment number 1-800-224-1234 Post Enrollment Numbers Toll-free number(s) PDP: 866-236-7376 MAPD: 866-236-7373 PAAD PDP: 866-236-7374 PAAD MAPD: 800-935-4102 Toll-free TTY number(s) 866-236-1069
Website (pre- and post-enrollment)	www.HorizonBlue.com/medicare
Grievance Phone Number	You may submit a grievance over the phone, by fax, or by letter. 1. To submit a grievance over the phone, call a grievance team member at 866-249-6176. 2. You may submit a grievance via fax at 866-788-5143. 3. Submit a grievance in writing to: Grievance Team, P.O. Box 280500, Nashville, TN 37228

*Secondary information applies when submitting claims to MAPD or PDP as secondary coverage.

PAAD and Senior Gold beneficiaries are also enrolled in a special secondary coverage. Please submit the primary claim to the MAPD or PDP coverage indicated above (from the beneficiary's card), and then a secondary claim to Unisys, RxBIN: 610515, RxPCN: PAAD, RxGRP: < not used >. See the beneficiary's card for the Member ID.