Eliminating Pre-Authorization Requirements for All Acute Care Hospital Admissions And Referral Requirements for Specialists
To ensure our members get the care they need, eliminate potential delays in admission and treatment, and help New Jersey hospitals deal with the increasing demand on staff resources, Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) is waiving pre-authorization and pre-certification for inpatient admissions at in-network acute care hospitals. The change took effect on March 27, 2020 and is in effect through April 30, 2020. It applies to every member and every plan type including Medicaid and Medicare. The Company is also eliminating permanently the requirement for members covered by its Medicaid plans to obtain a referral from their primary care doctor for specialist care. No Horizon plans require primary care physician referral for specialist care.
“Horizon is doing everything we can to make sure our members get the care they need during the COVID-19 pandemic. We take seriously our partnership with New Jersey’s hospitals and are working closely together to make it easier for them to focus all of their resources on delivering critical and life-saving care,” said Allen Karp, Horizon BCBSNJ’s Executive Vice President for Health Care and Transformation. “New Jersey’s hospitals are under incredible stress right now. Hospital staff who traditionally handle administrative matters like pre-authorizations are being pulled in to support critical care delivery. Horizon is in regular contact with all of our hospital and health system colleagues and will continue to enable our front-line health care partners as they take care of our members and our communities.”
Effective immediately, Horizon BCBSNJ is:
- For all inpatient admissions prior to or on April 30, 2020,
- Waiving pre-certification/prior authorization requirements for acute care facilities.
- Waiving admission review for acute care facilities.
- Waiving concurrent utilization review for members admitted to acute care facilities.
- Hospitals are still required to report the admission, date of discharge and diagnosis so claims can be processed without delay.
- Applying these changes to every health plan covering every member. This includes fully insured plans, Medicaid, Medicare, and all private and public plans Horizon administers on behalf of self-insured customers like the State Health Benefits Program and School Employee Health Benefits Program.
- Permanently waiving the requirement that Horizon NJ Health members obtain a referral from their primary care doctor to get outpatient care from a specialist. Horizon NJ Health members are reminded that their health plans cover care only when delivered by in-network doctors, specialists, and facilities.
Horizon BCBSNJ continues to monitor the COVID-19 pandemic and may extend these changes beyond April 30, 2020 as the situation dictates.