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Medicare Participation and Horizon BCBSNJ Participation

Horizon Blue Cross Blue Shield of New Jersey's administrative policy, Credentialing and Recredentialing Policy for Participating Physicians and Health Care Professionals, states that "Physicians and health care professionals who have opted out of Medicare may not participate in the Horizon Managed Care Network."

On a quarterly basis, our Credentialing Department reviews the Centers for Medicare & Medicaid Services (CMS) Opt-Out List and identifies any participating physicians or health care professionals who have opted out of Medicare.

  • Horizon Managed Care Network
    Physicians or health care professionals who have opted out of Medicare will be terminated from the Horizon Managed Care Network effective immediately.
  • Horizon PPO Network
    Physicians or health care professionals who have opted out of Medicare may continue to participate in our Horizon PPO Network. However, these practitioners are not eligible to receive reimbursement for services rendered to patients enrolled in one of our Medicare Advantage plans that include out-of-network benefits1 (except for emergency or urgent care services).

If you have questions, please contact your Network Specialist.

1 The Horizon BCBSNJ Medicare Advantage plans that offer out-of-network benefits include: Horizon Medicare Blue Access (HMO-POS), Horizon Medicare Access Group (HMO-POS), Horizon Medicare Blue (PPO), Horizon Medicare Blue Group (PPO) and Horizon Medicare Advantage NJ DIRECT (PPO).

Published on: September 20, 2017, 15:05 p.m. ET
Last updated on: September 20, 2017, 15:07 p.m. ET