Waiving Prior Authorization Requirements for Emergent In-Network Inpatient Admissions and Post-Acute Facility Admissions

As we continue to see a rise in COVID-19 hospitalizations and the need to divert all available health care resources to patient care, Horizon BCBSNJ is committed to working with doctors, hospitals and post-acute facilities to assist our members in accessing necessary treatment. At the same time, we want to help reduce the administrative burden on network hospital staff. We are implementing the following changes effective immediately for all Horizon BCBSNJ members, including those covered through Medicaid, Medicare Advantage, FIDE-SNP, fully insured and self-insured policies as well as for Braven Health plans. These changes do not apply to Federal Employee Program® (FEP®) members.

Emergent inpatient admissions

Horizon BCBSNJ has waived prior authorization requirements for emergent inpatient admissions to in-network general acute care hospitals on or after November 30, 2020. This change will be effective through January 18, 2021 and we will evaluate the public health crisis at this time.

Effective immediately, for all in-network inpatient admissions as of November 30, 2020, Horizon BCBSNJ is waiving the following for emergent inpatient admissions:

  • Prior authorization requirements
  • Admission reviews
  • Concurrent utilization reviews

Horizon BCBSNJ will continue to require notice of admissions for all hospital inpatient stays before claims are submitted.

Post-Acute Facility Admissions

In order to allow hospitals to optimize capacity to treat patients with acute conditions, including COVID-19, Horizon BCBSNJ will also waive post-acute facility inpatient authorization requirements for admissions to in-network Skilled Nursing, Subacute Physical Rehabilitation and Inpatient Acute Physical Rehabilitation facilities for dates of admission on or after November 30, 2020. This change does not apply to Long Term Acute Care Hospitals (LTACHs). This change will be effective through January 18, 2021 and we will evaluate the public health crisis at this time.

Horizon BCBSNJ will continue to require notice of post-acute admissions before claims are submitted.

The following will take effect for confinements in in-network post-acute facilities where the date of admission is on or after November 30, 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 member’s applicable benefit plan or the agreed-upon rate.

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