Administrative Policy Revision: Provider Directory Management
Effective May 1, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way we address situations in which we are unable to validate whether information included within our provider files is current and accurate.
Our revised Provider Directory Management administrative policy outlines the process Horizon BCBSNJ staff and business partners acting on our behalf will take as they work to ensure that the information within our provider files is correct. This revised policy also outlines actions that will be taken in regard to provider directory inclusion and continued participation of practice location(s) and/or practitioners whose information we are unable to validate.
It’s critical that provider file information is accurate and up-to-date as this information is used to populate our Doctor & Hospital Finder, inaccurate or outdated information may result in a misrepresentation of your practice to patients and referring physicians or other health care professionals searching our Doctor & Hospital Finder.
We encourage you to review our Provider Directory Management administrative policy online.
To access this information, registered NaviNet users may sign in to NaviNet.net, select Horizon BCBSNJ from the My Health Plans menu and:
- Mouse over References and Resources and click Provider Reference Materials.
- Mouse over Policies & Procedures and click Policies.
- Click Administrative Policies.
- Click Provider Directory Management.
Based on the guidelines within our Provider Directory Management administrative policy:
- Horizon BCBSNJ validates practitioner information every 90 days through outreach efforts conducted by our business partners, CAQH and Atlas Systems. These outreach efforts seek to validate that the information we have on file is accurate.
Our business partners will pursue their outreach for a period of 90 days.
- If the initial outreach efforts of our business partner(s) are not successful, Horizon BCBSNJ staff will conduct a secondary 90-day outreach effort to validate that the information we have on file is accurate.
While this secondary outreach is conducted, the information pertaining to practitioners in question will be suppressed from appearing within our online Doctor and Hospital Finder.
- If, at the end of this second 90-day period, we are unable to validate that the information we have on file is accurate, the practice location(s) and/or practitioner in question will be terminated from all Horizon BCBSNJ networks.
If you have questions, please contact your Network Specialist.
Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be effective May 1, 2017.
Horizon BCBSNJ strongly encourages all participating practitioners to use CAQH ProViewTM to maintain their Horizon BCBSNJ provider file information.
- Practitioners should access CAQH ProViewTM as soon as demographic/practice information changes to make updates as appropriate, and then re-attest that information is current, accurate and complete.
- Practices should ensure that practice roster information is up to date.
- Horizon BCBSNJ captures all CAQH updates on a weekly basis and incorporates this information into our provider files
If you do not want Horizon BCBSNJ to access your CAQH information, please remove Horizon BCBSNJ from your CAQH profile.
If you’re not registered with CAQH, please:
- Visit caqh.org/pr to self-register with CAQH. Upon completion of the self-registration process, you will receive a CAQH welcome email with your unique CAQH Provider ID number.
- Visit caqh.org, mouse over CAQH Proview and select Log In.
- Complete an online application (ensure that you select Horizon BCBSNJ so that we can access your information) and then attest that the information is accurate and complete.