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Horizon Response Statement on Medicaid

June 21, 2017 statement from spokesman Kevin McArdle:

“For the last seven years, Horizon New Jersey Health (Horizon NJH) has saved New Jersey Medicaid an estimated $1.5 billion through our provider network and medical management practices while delivering better care. Horizon NJH spends less than any other carrier in New Jersey's Medicaid market on administrative costs and more on medical and other direct benefits while having the lowest net income per member per month. According to the most recent NJ Annual report on FamilyCare, prepared by the NJ Department of Human Services, Horizon NJ Health received the highest scores in health care quality and health plan. 

In 2016, with the approval of the administration and for the purpose of creating substantial savings for the State, Horizon NJH undertook a complicated transition transferring responsibility for Medicaid claims processing to a different vendor, one expected to help lower costs over time. Horizon NJH recognized that such transitions are difficult and voluntarily reported to the State problems associated with the implementation that resulted in payments being delayed to some providers. The problems have since been remediated and our current claims payment timeliness complies with both the contract and all state regulations. We are not aware of a single member whose care was impacted in any way.Horizon NJH was in contact with affected providers throughout and provided payment advances to providers who were impacted and made interest payments on any late claims. Throughout the process, we provided weekly detailed actions plans and statistics that enabled the State to track our progress and provide feedback.

Given the substantial progress and success we achieved in working with the State, we were blindsided by both the timing and severity of this action. It makes us question the motivation behind levying a large, and unreasonable, penalty without permitting the opportunity for the customary appeal and review. The State appears to have used an incorrect data set to calculate the penalty and the conclusions contained in the State’s letter are wrong as a result. Horizon NJH will be filing a formal challenge to this unfair and unjustified action.

For 7 years, the Governor had nothing to say about Horizon. His comments strongly suggest that this is further retaliation for Horizon’s unwillingness to submit to his demand for $300 million from the reserves we hold to protect our members and an abuse of power.” 

About Horizon Blue Cross Blue Shield of New Jersey

About Horizon Blue Cross Blue Shield of New Jersey

Horizon Blue Cross Blue Shield of New Jersey, the state's oldest and largest health insurer is a tax-paying, not-for-profit health service corporation, providing a wide array of medical, dental, vision and prescription insurance products and services. Horizon BCBSNJ is leading the transformation of health care in New Jersey by working with doctors and hospitals to deliver innovative, patient-centered programs that reward the quality, not quantity, of care patients receive. Learn more at www.HorizonBlue.com. Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association serving more than 3.8 million members.