Effective February 1, 2017, Horizon Blue Cross Blue Shield of New Jersey has named naviHealth, LLC as a delegated partner in the management of the post-acute Skilled Nursing Facility (SNF) and Inpatient Acute Rehab Facility (IRF) benefits for our Medicare Advantage and Horizon Medicare Advantage NJ DIRECT (PPO) members.
Dual-Eligible Special Needs Plan (DSNP) members enrolled in Horizon NJ TotalCare (HMO SNP) are not currently serviced by naviHealth. Physicians and other health care professionals will be notified prior to the implementation of naviHealth for DSNP members.
naviHealth offers a comprehensive suite of evidence-based functional assessment and clinical decision-support care solutions. naviHealth care coordinators collaborate with patients, caregivers and facility Care Managers to provide care transition planning and clinical review authorizations of post-acute care services. The primary goal of the program is to support a patient through his/her recovery process in the most appropriate, least restrictive setting.
In this program, prior authorization must be obtained from naviHealth for admission and concurrent stay in a SNF or IRF for our Medicare Advantage and Horizon Medicare Advantage NJ DIRECT (PPO) members.
As of February 1, 2017, authorization requests for post-acute care can be made by calling naviHealth at 1-844-884-2423 from 8 a.m. to 5 p.m., Eastern Time (ET). naviHealth may be reached daily except for nationally recognized holidays. Physicians and other health care professionals can also fax naviHealth at 1-866-683-5009 for pre-service authorization requests for post-acute care, or at 1-866-683-5158 for continued stay authorization requests for post-acute care during and outside these business hours.
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