Introducing the Horizon BCBSNJ Chiropractic & Physical Medicine Services Program with American Specialty Health Group
Horizon Blue Cross Blue Shield of New Jersey has contracted with American Specialty Health Group, Inc. (ASH Group) with plans to administer our Chiropractic & Physical Medicine Services Program beginning on January 1, 2020. Pending regulatory approval, ASH Group will be responsible for practitioner contracting, contract administration, medical necessity review and claims processing for in-scope Horizon BCBSNJ members.
As part of this program, impacted practitioners will need to submit claims for Medical Necessity Determination (MND) review to ASH for the following services:
- Occupational Therapy
- Physical Therapy
The guidelines of this program is planned to apply to members who are enrolled in fully insured, Federal Employee Program® (FEP®), Medicare Advantage, and self-funded Administrative Services Only (ASO) groups.
The guidelines of this program will apply to fully insured members enrolled in programs through other Blue Cross and Blue Shield plans that include BlueCard benefits when these members reside or travel in Horizon BCBSNJ's local service area and receive services from a participating practitioner.
Members enrolled in the following plans/products are NOT included:
- Horizon NJ Health plans
- Horizon NJ TotalCare (HMO SNP)
- Medicare Supplemental
What to Know
In anticipation of the January 1 launch, providers must complete the Horizon BCBSNJ amendment and ASH recruitment package sent by ASH by November 1, 2019. This package includes ASH’s credentialing application and contracting materials.
The eligible in-scope practitioners who return the required materials to ASH by November 1, 2019 can continue to treat members at an in-network level of benefits. Credentialed practitioners will become effective with the ASH network on January 1, 2020.
Horizon BCBSNJ will continue to manage services through December 31, 2019 for practitioners who treat members with managed care benefit plans.
After January 1, 2020, all contracted and credentialed providers will follow ASH’s clinical performance program and medical necessity review guidelines.
What if I don’t contract with ASH?
In order for you to continue to be a credentialed practitioner with Horizon BCBSNJ, you must sign the Horizon BCBSNJ Subordination Agreement Amendment and contract with ASH by November 1, 2019.
If you do not sign the Horizon BCBSNJ Subordination Agreement Amendment and contract with ASH by November 1, 2019, your Horizon BCBSNJ Provider Agreement(s) will terminate in accordance with your agreement.
The Horizon BCBSNJ Chiropractic & Physical Medicine Services Program is subject to regulatory approval.
For questions about this program
- Access program FAQs
- Call ASH at 1-888-511-2743 Monday through Friday from 10 a.m. to 8 p.m. Eastern Time (ET), or Horizon BCBSNJ Physician Services at 1-800-624-1110, Monday through Friday, 8 a.m. to 5 p.m. ET.
American Specialty Health Group, Inc. is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey in the administration of chiropractic and physical medicine services. American Specialty Group, Inc. is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.