Provider Directory Management Policy
Our Provider Directory Management administrative policy outlines the processes we follow in regard to ensuring that the information within our provider files is correct, current and complete, including our approach to the display of information about, and the continued participation of, practice location(s) and/or practitioners whose information we are unable to validate.
Based on the guidelines of our Provider Directory Management administrative policy:
- Horizon BCBSNJ validates practitioner information every 90 days through outreach efforts conducted by our business partners, CAQH and Atlas Systems. These outreach efforts seek to validate that the information we have on file is accurate.
Our business partners will continue their outreach for a period of 90 days.
- If the initial outreach efforts of our business partner(s) are not successful, Horizon BCBSNJ staff will conduct a secondary 90-day outreach effort to validate that the information we have on file is accurate.
While this secondary outreach is conducted, the information pertaining to practitioners in question will be suppressed from appearing within our Doctor & Hospital Finder.
- If, at the end of this second 90-day period, we are unable to validate that the information we have on file is accurate, the practice location(s) and/or practitioner in question will be terminated from all Horizon BCBSNJ networks.
We strongly encourage you to review our Provider Directory Management administrative policy.