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

On April 28, 2020, Horizon BCBSNJ extended the date of these prior authorization changes with updates, from April 30, 2020 to May 31, 2020.

During this COVID-19 pandemic, Horizon BCBSNJ continues to work with doctors, hospitals and post-acute facilities to provide the most effective treatment of our members 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 utilization review of care in the post-acute facility setting.

The change is effective immediately for Horizon BCBSNJ members, including those covered through Medicaid, Medicare, 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, unless extended, Horizon BCBSNJ will waive post-acute facility inpatient authorization requirements for admissions to Skilled Nursing, Subacute Physical Rehabilitation and Inpatient Acute Physical Rehabilitation facilities for dates of admission 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 confinements in post-acute facilities where the date of admission is 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. If you have a patient with a COVID-19 diagnosis, please report the diagnosis for tracking purposes.
  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.

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

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