Administrative Policy: Credentialing and Recredentialing During the COVID-19 Pandemic
Effective March 27, 2020, Horizon BCBSNJ has implemented a new policy, Credentialing and Recredentialing During the COVID-19 Pandemic, that allows for a temporary change in its credentialing and recredentialing processes and procedures for certain practitioner specialties.
This change – which aligns with the Centers for Medicare & Medicaid Services (CMS), New Jersey Department of Banking and Insurance (DOBI) and the National Committee for Quality Assurance (NCQA) guidelines – will help providers offer greater access to the care our members need during the COVID-19 pandemic.
These temporary credentialing changes include:
- Acceptance of a temporary New Jersey License
- Provisional credentialing for up to 180 days
This policy defines the credentialing requirements for practitioners who are licensed outside of Horizon BCBSNJ’s local service area who are able to provide telemedicine or in-person medical services to our members during the COVID-19 pandemic. It will also apply to practitioners who may be new to, or retired from, a practice.
This policy applies to Horizon BCBSNJ commercial and Horizon NJ Health plans/products including:
- Direct Access
- HMO
- Horizon NJ TotalCare (HMO D-SNP)
- Medicaid
- Medicare Advantage
- POS
- PPO
SUBMISSION OF INFORMATION
Horizon BCBSNJ Provider Agreements
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.
Email completed and signed PROVISIONAL CREDENTIALING APPLICATIONS along with completed and signed Provider Agreement(s) to COVID19_Credentialing@HorizonBlue.com.
Provisional Credentialing
Practitioners who are applying to assist with the COVID-19 pandemic will be provisionally credentialed unless a full application is submitted and meets all of the requirements as stated in the Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals. Practitioners who receive provisional credentialing will be required to submit an application for full credentialing if they wish to continue participation in one or more of our networks once the provisional credentialing period ends.
Practitioners who are solely practicing in the hospital will be required to submit a Hospital Based Application.
Review more information about temporarily joining our networks.