Dates for Prior Authorization Waivers Extended

Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions

Horizon BCBSNJ has waived precertification/prior authorization requirements for inpatient admissions on or prior to May 31, 2020. These changes are for all Horizon BCBSNJ members, including those covered through Medicaid, Medicare, fully insured and self-insured policies. These changes apply to all inpatient admissions at acute care facilities

Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility Admissions

The change is effective immediately for Horizon BCBSNJ members, including those covered through Medicaid, Medicare Advantage, FIDE-SNP, fully insured and self-insured policies. This does not apply to Federal Employee Program® (FEP®) members.

Effective immediately and through May 31, 2020, Horizon BCBSNJ has extended the waiver for post-acute facility inpatient authorization requirements for admissions to Skilled Nursing, Subacute Physical Rehabilitation and Inpatient Acute Physical Rehabilitation facilities for admissions prior to or on May 31, 2020. This change does not apply to Long Term Acute Care Hospitals (LTACHs).

The following will take effect for admissions to post-acute facilities prior to or on May 31, 2020:

  1. The Notice of Admission can be submitted by the post-acute facility, hospital or health care professional via our online Utilization Management Request Tool accessed on NaviNet®, phone or fax as noted below.
  2. Please include a diagnosis when submitting a request, especially if it is a COVID-19 diagnosis.
  3. Clinical review for the admission will be waived.
  4. Out-of-network receiving facilities should notify Horizon BCBSNJ of the admission. Out-of-network facilities will be paid per the terms of the applicable benefit plan or the agreed-upon rate.
  5. Update: When you have a patient in a post-acute facility for longer than 14 days, concurrent review will be applied.

Contact Information for all Post-Acute Facility Requests:

Horizon NJ Health Members

Phone: 1-800-682-9094, Ext. 89104
Fax: 1-973-274-3867

Medicare Advantage & FIDE-SNP Members

Phone: 1-844-884-2423 (naviHealth)
Fax: 1-866-683-5009

Horizon BCBSNJ Commercial Members

Submit PAFs via our online Utilization Management Request Tool accessed on NaviNet.
Phone: 1-844-243-3450

These changes are effective until May 31, 2020, subject to extension by Horizon BCBSNJ as the COVID-19 pandemic evolves.