Provisionally (Temporarily) Join Horizon BCBSNJ Network(s) to Assist with the COVID-19 Pandemic

To help ensure that our members have access to the telemedicine and in-person health and behavioral health services they need during the COVID-19 pandemic, Horizon BCBSNJ and Horizon NJ Health invite doctors and other health care professionals licensed in states outside of our local service area or those who are retired to submit requests to provisionally join our networks.

Following the state of New Jersey’s decision to waive certain regulatory provisions regarding licensure of health care practitioners through reciprocity, Horizon BCBSNJ and Horizon NJ Health have amended our criteria to allow for provisional credentialing of doctors and other health care professionals licensed in states outside our local service area.

Thanks in advance for your interest in helping our members. Here’s what you need to do:

1. Complete a Horizon BCBSNJ Provisional Credentialing application

   Complete and sign the appropriate application below:

   • Telemedicine or office-based practitioners who wish to be provisionally credentialed into our network(s) should complete our APPLICATION FOR PROVISIONAL PARTICIPATION.
   • Practitioners affiliated ONLY with a hospital-based practice who wish to be provisionally credentialed into our network(s) should complete our PROVISIONAL APPLICATION FOR HOSPITAL-BASED PRACTITIONERS

   Applications will be reviewed by the Credentials Committee and determinations will be made in accordance with our provisional credentialing criteia.

2. Complete a Horizon BCBSNJ Provider Agreement

   Request, complete and sign the appropriate Horizon BCBSNJ Provider Agreement(s).

   To obtain a copy of our Agreement(s), email your request to COVID19_Credentialing@HorizonBlue.com.
   Please indicate your provider specialty along with the Agreement(s) (below) you are seeking.

   • Our Horizon Healthcare of New Jersey, Inc. Agreement with Participating Physicians and Other Healthcare Professionals is for participation in the Horizon Managed Care Network which will allow you to treat members enrolled in Horizon BCBSNJ managed care plans (e.g., OMNIA Health Plans, Horizon HMO, Horizon Direct Access, Horizon Medicare Advantage).
   • Our Horizon Blue Cross Blue Shield of New Jersey Agreement with Participating Physicians and Healthcare Professionals is for participation in the Horizon PPO Network which allows you to treat members enrolled in Horizon BCBSNJ PPO and Indemnity Plans.
   • Our Horizon Government Programs Individual Provider Agreement is for participation in the Horizon NJ Health Networks that will allow you to treat members enrolled in Horizon NJ Health Medicaid, NJ FamilyCare, Managed Long Term Services & Supports (MLTSS), Horizon NJ TotalCare (HMO SNP) plans.

3. Obtain NJ Accelerated temporary-licensure-by-reciprocity

   Providers without NJ medical licenses must obtain a provisional license by following the NJ accelerated temporary-licensure-by-reciprocity process and requirements.

   • Forms are available at www.njconsumeraffairs.gov/Pages/Accelerated-Temporary-Licensure.aspx.
   • Eligible practitioners will be deemed licensed upon submission of a completed form to NJtemplicense@dca.njoag.gov.

   Licenses granted through this process will be valid for 180 days, with an additional 180-day extension available upon written request. Health care practitioners who complete the accelerated licensure process will be able to provide telemedicine and telehealth services on the same terms as other New Jersey licensees.

4. SUBMIT YOUR APPLICATION
   Email completed and signed Credentialing Application along with your completed and signed ProviderAgreement(s) to COVID19_Credentialing@HorizonBlue.com

OUR CREDENTIALING PROCESS
Our Credentialing/Recredentialing Department willcontact you if additionalinformationis neededto begin the credentialing process. If all required information is not included, the application will be withdrawn and you will have to submit a new application.

You will be notified if your application has been approved or denied.

If approved by the Horizon BCBSNJ Credentials Committee, you will receive a letter that includes your participation effective date, and copies of the fully executed Provider Agreement(s).

Questions
Please email us at COVID19_Credentialing@HorizonBlue.com.