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Update: Prior Authorization Requirements for Inpatient Admissions and Post-Acute Facility Admissions to be Reinstated

Horizon BCBSNJ and Braven Health will be reinstating certain prior authorization requirements as noted below.

Inpatient Admissions and Concurrent Reviews

Prior authorization requirements will be reinstated for emergent inpatient admissions and concurrent reviews for in-network general acute care hospitals effective:

  • February 1, 2021, for Horizon BCBSNJ members, including Medicaid, and fully insured and self-insured members.
  • March 1, 2021, for Medicare Advantage, Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNP) and Braven Health members.

Post-Acute Facility (PAF) Admissions

Effective March 1, 2021, post-acute facility inpatient authorization requirements for admissions to in-network Skilled Nursing, Subacute Physical Rehabilitation and Inpatient Acute Physical Rehabilitation facilities will be reinstated.

This change applies to:

  • All Commercial Horizon BCBSNJ members, including fully insured and self-insured
  • Medicaid, Medicare Advantage and Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNP) members
  • All Braven Health members

How to submit PAF requests:

  • For Horizon NJ Health members:
    Online: The Utilization Management Request Tool accessed on NaviNet®
    Phone: 1-800-682-9094, Ext. 89104
    Fax: 1-973-274-3867
  • For Horizon BCBSNJ Commercial, Medicare Advantage & FIDE-SNP Members and Braven Health members:
    Online: The Utilization Management Request Tool accessed on NaviNet Phone: 1-844-243-3450