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Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions

Horizon BCBSNJ continues to work with doctors and hospitals to help treat patients during this pandemic. We appreciate everyone’s dedication within the health care system. To help you continue to treat your patients, we are waiving certain administrative requirements for inpatient care at acute facilities, recognizing the diversion of staff needed to dedicate to the COVID-19 patients.

Horizon BCBSNJ has waived precertification/prior authorization requirements for inpatient admissions with date of admission on or prior to April 30, 2020, unless extended. These changes take effect immediately for all Horizon BCBSNJ members, including those covered through Medicaid, Medicare, fully insured and self-insured policies. These changes apply to all inpatient admissions at acute care facilities.

Effective immediately, for all inpatient admissions prior to or on April 30, 2020, Horizon BCBSNJ is waiving:

  • Precertification/prior authorization requirements
  • Admission reviews
  • Concurrent utilization reviews

Horizon BCBSNJ will continue to require notice of admissions for all hospital inpatient stays before claims are submitted. If you have a patient with a COVID-19 diagnosis, please report the diagnosis for tracking purposes for applicable inpatient stays.

Discharging patients

The discharging process will remain the same to ensure that patients are safely and appropriately discharged. Please continue to submit authorizations requests for any discharge needs and provide notification of discharge date to ensure timely claims payment.

If you are experiencing any difficulties when discharging a COVID-19 patient, please notify us immediately for assistance.

These changes are effective until April 30, 2020, subject to extension by Horizon BCBSNJ as the COVID-19 pandemic evolves.

Published on: March 30, 2020, 08:44 a.m. ET
Last updated on: April 27, 2021, 02:34 a.m. ET