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Important Information Regarding the Horizon Behavioral Health℠ Program

As previously communicated, Horizon Blue Cross Blue Shield of New Jersey and Horizon NJ Health will transition the administration and clinical management of behavioral health services from Beacon Health Options (formerly ValueOptions) to our internal operations.

Below is important information related to this transition, including:

  • The credentialing of new behavioral health providers and ancillary facilities who wish to join one of our networks.
  • How to update existing provider demographic information.
  • The medical necessity criteria to be used to make utilization management determinations for behavioral health services.

CREDENTIALING AND PROVIDER DEMOGRAPHIC UPDATES
Beginning October 1, 2019, all behavioral health professionals and ancillary facilities will work directly with Horizon BCBSNJ for:

  • Provider Demographic Updates: Changes to the demographic/provider file information of currently participating behavioral health professionals and ancillary facilities.

  • Credentialing: The initial credentialing of nonparticipating behavioral health professionals and ancillary facilities who are seeking to join one of our network(s).

Effective October 1, 2019, Beacon Health Options will no longer perform these processes as part of the Horizon Behavioral Health program. Beacon Health Options will continue to manage all provider demographic updates and initial credentialing requests received prior to October 1, 2019.

MEDICAL NECESSITY CRITERIA
Beginning in 2020, Horizon BCBSNJ, Horizon NJ Health and Horizon NJ TotalCare (HMO SNP) will use the behavioral care guidelines from MCG Health, LLC (MCG) to help us make behavioral health care utilization management determinations. This change impacts all network behavioral health providers.

We will continue to use American Society of Addiction Medicine (ASAM) criteria when making coverage determinations for services related to Substance Use Disorders.

As noted below, the 2020 effective dates of our transition to MCG Behavioral Health Care Guidelines (and no longer using Beacon Health Options’ medical necessity criteria) will coincide with our overall transition plan.

Effective... MCG Behavioral Health Care Guidelines will be used to help make behavioral health care coverage determinations for members enrolled in ...
January 1, 2020
  • Horizon Medicare Advantage plans
  • Horizon NJ Health plans – including Division of Developmental Disabilities (DDD), NJ FamilyCare and Managed Long Term Services & Supports (MLTSS)¹
  • Horizon NJ TotalCare (HMO SNP)

April 1, 2020

  • All other Horizon BCBSNJ plans – including fully insured plans/products, self-insured (Administrative Services Only [ASO]) employer group plans including the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP) and the Federal Employee Program® (FEP®)

FOR MORE INFORMATION
Review Horizon Behavioral Health Program: Change in Management Frequently Asked Questions.

 

¹Behavioral health outpatient services for Horizon NJ Health members who are not DDD or MLTSS are covered through Medicaid Fee for Service and not impacted by this change.

The Horizon Behavioral Health ℠ program is administered by ValueOptions of New Jersey, Inc. ValueOptions of New Jersey, Inc., a subsidiary of Beacon Health Options, Inc., is a New Jersey Corporation licensed by the NJ Department of Banking & Insurance as an Organized Delivery System.

Products are provided by Horizon Insurance Company and/or Horizon NJ Health. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. All are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols, FederalEmployee Program® and FEP® are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks, and Horizon Behavioral
Health
is a service mark of Horizon Blue Cross Blue Shield of New Jersey.

Published on: September 23, 2019, 02:56 AM ET
Last updated on: September 19, 2019, 15:40 PM ET