Update on Chiropractic & Physical Medicine Services Program
As you know, beginning January 1, 2020, Horizon BCBSNJ plans to collaborate with American Specialty Health (ASH) with plans to implement and administer our Chiropractic & Physical Medicine Services Program, which will include the following services:
• Occupational Therapy (OT)
• Physical Therapy (PT)
It has come to our attention that some health care professionals and associations are relaying false information about this program to their patients and the public.
Here is what you should know:
Every provider currently participating in Horizon BCBSNJ’s network(s) is being invited to continue providing in-network care to our members.
Member benefits are not changing
Member benefits for acupuncture, chiropractic, occupational therapy and physical therapy are not changing as a result of this collaboration with ASH. There are no changes in cost sharing responsibilities.
• Members’ terms of coverage is not changing.
• Member cost-sharing responsibilities are not changing.
• There are no new limitations on the number of visits covered by plans.
• Members are not required to get services or visits pre-approved.
• ASH-contracted providers are required to hold members harmless for any financial
responsibility if services are not determined to be medically necessary.
Below are answers to questions you may have:
What is American Specialty Health (ASH)?
American Specialty Health (ASH) is a personal health improvement company that Horizon BCBSNJ is working with to offer clinical benefits, fitness programs, health coaching and provider network management to improve the overall health of our members as part of our Chiropractic & Physical Medicine Services Program.
ASH will perform pre- and post-service medical necessity determination (MND) reviews for the services noted above when rendered in an office setting by participating and nonparticipating practitioners.
ASH is a recognized leader in collaborating with providers in New Jersey and across the country to manage the network of providers delivering these specialty services. ASH works with two health plans here in New Jersey, more than 20 Blue Cross Blue Shield plans around the country and over 100 health plans nationally.
Will member benefits change?
This collaboration will not impact covered member benefits in any way. There are no changes to the number of visits covered by members’ plans and no change to cost sharing responsibility (deductible, copayment or coinsurance) for these services.
Will member out-of-pocket expenses change when the Chiropractic & Physical Medicine Services Program begins?
No. There are no changes to a member’s cost-sharing responsibilities or to the quantity of the services members can receive under their health plan.
What procedures will ASH perform MND review for as part of this program?
ASH will manage pre- and post-service MND reviews for the following types of services rendered in an office setting:
- Occupational Therapy (OT)
- Physical Therapy (PT)
Services rendered inpatient, outpatient or in the home are excluded from the program.
How can I participate with ASH?
Every provider currently participating in Horizon BCBSNJ’s network(s) is being invited to continue providing in-network care to our members. Impacted practitioners received detailed information about this program and all applicable documents for credentialing and contracting with ASH.
In anticipation of the January 1 launch, practitioners must complete the Horizon BCBSNJ Subordination Agreement Amendment and ASH recruitment package by November 1, 2019.
What is the effective date of the ASH network for participating providers?
Beginning January 1, 2020, Credentialed practitioners are planned to become effective with the ASH network.
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.