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New Post-Acute Facility Prior Authorization Process for Medicare Advantage and Horizon NJ TotalCare (HMO D-SNP) Members

To make things more convenient for our network providers, we have simplified the prior authorization process for post-acute facilities.

Beginning January 1, 2021, our internal Utilization Management teams will be managing prior authorization requests for Medicare Advantage and Horizon NJ TotalCare (HMO D-SNP) member admissions and continued stays in the following post-acute facilities:

  • Inpatient Rehabilitation Facility (IRF)
  • Subacute Rehabilitation Facility (SAR)
  • Skilled Nursing Facility (SNF)  

On and after January 1, 2021, please submit all post-acute facility prior authorization requests directly to Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) and/or Horizon NJ Health via our online Utilization Management Request Tool on NaviNet® or by calling 1-800-682-9094, ext. 89104.

Effective January 1, 2021, you will no longer submit prior authorizations for post-acute facilities to NaviHealth. If a prior authorization was approved for days that extend beyond December 31, 2020, Horizon BCBSNJ will work with NaviHealth to transition the authorizations.

Training

To request an educational session on using our online tool, please contact:

Questions

If you have any questions regarding this change, please contact:

Horizon BCBSNJ (Medicare Advantage)

We are excited to insource prior authorizations at this time and ensure a consistent process between acute care hospitals and post-acute care facilities.

 

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Published on: October 1, 2020, 09:05 a.m. ET
Last updated on: September 29, 2020, 16:16 p.m. ET