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Hackensack-Meridian Health Partners to Oversee Utilization Management (UM) and Care Management for certain Braven Health members

Effective January 1, 2021, Hackensack-Meridian Health Partners (HMHP) will oversee UM and Care Management activities for Braven Health members who are contact attributed to HMHP physicians through a Horizon Blue Cross Blue Shield of New Jersey value-based program.

Braven Health members attributed to HMHP physicians through a value-based program are Braven Health members who have actively selected HMHP Primary Care Physicians or whose claims history are associated with HMHP PCPs.

This change represents the next phase of value-based care, as it will give Hackensack Meridian Health more medical management responsibility. It is the latest way Horizon BCBSNJ is working with our value-based partners to give them the tools and resources they need to provide high quality, efficient care.

What this means for you

This change does not impact our medical policies, or any of your existing processes or procedures when seeking prior authorization. You can continue to log in to NaviNet® as you currently do to request authorization, or call 1-800-664-BLUE (2583), and you will be routed to the appropriate contact at HMHP. The HMHP Complex Case management team will identify and outreach to members who may need assistance or transitions of care.

What is not changing

HMHP will not oversee UM activities for services that Horizon BCBSNJ and Braven Health currently delegate. The services below will continue to be managed by Horizon BCBSNJ and Braven Health through existing vendor relationships:

  • Pharmacy (Prime Therapeutics )
  • Radiology/Cardiology, Radiation Therapy and Pain Management (eviCore healthcare)
  • Medical Injectables (MagellanRx)
  • DME and IV home infusion (CareCentrix)
  • Implantables (TurningPoint)

Horizon BCBSNJ and Braven Health will also continue to oversee UM activities for behavioral health services, through the Horizon Behavioral Health℠ program.

Important Reminders

  • Participation in Braven Health plans is based on your current participation with existing Horizon Medicare Advantage plans. Braven Medicare Choice (PPO), Braven Medicare Freedom (PPO), Braven Medicare Group (HMO-POS) and Braven Medicare Access Group (HMO-POS) plans will use the broad Horizon Managed Care Network and the broad Horizon Hospital Network. Braven Medicare Plus (HMO) will use the same subset of the Horizon Managed Care Network and the Horizon Hospital Network used by Horizon BCBSNJ Medicare Blue Advantage (HMO) plans.
  • Braven Health will follow Horizon BCBSNJ’s policies and procedures, including its medical policies.
  • Horizon BCBSNJ will provide back-office operations, including network management, claims, customer service and provider services required to operate a Medicare Advantage plan.
  • Braven Health will have its own Payer ID (84367). All trading partners and direct submitters will need to register for Braven Health EDI prior to January 1, 2021.

If you have any questions, please call Provider Services at 1-800-624-1110. For more information about Braven Health, please visit HorizonBlue.com/BravenHealth.

Hackensack Meridian Health Partners is a New Jersey licensed organized delivery system.Prime Therapeutics LLC is an independent company that provides pharmacy benefit management services for Horizon Blue Cross Blue Shield of New Jersey NaviNet® is a registered trademark of NaviNet Inc., an independent company providing provider portal service on behalf of Horizon Blue Cross Blue Shield of New Jersey. Magellan Rx Management is a specialty pharmaceutical management company that administers the Horizon BCBSNJ Medical Injectables Program (MIP). CareCentrix, Inc., is a Delaware corporation and its subsidiary, CareCentrix of New Jersey, Inc., a New Jersey Corporation licensed by the NJ Department of Banking and Insurance as an Organized Delivery System to administer certain services for the Horizon Care@Home program. TurningPoint Healthcare Solutions, LLC supports Horizon Blue Cross Blue Shield of New Jersey in the administration and utilization management review of certain orthopedic and cardiac services for coverage.

OMNIA℠ and Horizon Behavioral Health℠ are service marks of Horizon Blue Cross Blue Shield of New Jersey. All other trademarks and trade names are the property of their respective owners.

Products are provided by Horizon Blue Cross Blue Shield of New Jersey, Horizon Insurance Company, Horizon Healthcare of New Jersey, Braven Health and/or Horizon NJ Health, each company is an independent licensee of the Blue Cross and Blue Shield Association. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. The Braven Health name and symbols are a service mark of Braven Health.

Published on: November 23, 2020, 03:05 a.m. ET
Last updated on: November 23, 2020, 05:31 a.m. ET