Pre-Certification/Prior Authorization requirements for Post-Acute Facility Admissions
We continue to work with doctors, hospitals and post-acute facilities to help you provide the most effective treatment and the most efficient use of limited health care resources. To reduce the burden of hospital staff involved in the discharge planning process, we are waiving certain administrative requirements for prior authorization.
The change is effective immediately for Horizon members, including those covered through Medicaid, Medicare Advantage (including those covered by Horizon’s affiliate, Braven Health), FIDE-SNP, fully insured and self-insured policies including the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP) members. This does not apply to Federal Employee Program® (FEP®) members.
Effective immediately and through February 28, 2022, unless extended, Horizon will waive prior authorization for transfers from in-network, acute or mental health hospitals to in-network skilled nursing facilities or subacute rehabilitation facilities for dates of admission prior to or on February 28, 2022. This change does not apply to Long Term Acute Care Hospitals (LTACHs), in-network acute inpatient rehabilitation facilities, subacute detox facilities or post-acute facility admissions for custodial care.
- The Notice of Admission must be submitted by the post-acute facility, hospital or health care professional via our online Utilization Management Request Tool accessed on NaviNet®, or by using the contact information listed below.
- Please include the diagnosis when submitting a request.
- Only the clinical review for the admission will be waived.
- Horizon Commercial Members:
- Horizon Medicare Advantage, Braven Health & FIDE-SNP
Members and Horizon NJ Health Members:
Phone: 1-800-682-9094, Ext. 89104