Horizon eliminates pre-authorization reqs for acute care hospital admissions

Anthony Vecchione//March 30, 2020

Horizon Blue Cross Blue Shield of New Jersey announced Monday it is waiving pre-authorization and pre-certification for inpatient admissions at in-network acute care hospitals.

The change took effect on March 27, and is in effect through April 30, 2020. It applies to every member and every plan type including Medicaid and Medicare.

Effective immediately, Horizon BCBSNJ is:

Waiving pre-certification/prior authorization requirements for acute care facilities
Waiving admission review for acute care facilities
Waiving concurrent utilization review for members admitted to acute care facilities (Hospitals are still required to report the admission, date of discharge and diagnosis so claims can be processed)

Changes are applicable to every health plan covering every member, including fully insured plans, Medicaid, Medicare, and all private and public plans Horizon administers on behalf of self-insured customers, like the State Health Benefits Program and School Employee Health Benefits Program

The company is also eliminating permanently the requirement for members covered by its Medicaid plans to obtain a referral from their primary care doctor for specialist care. No Horizon plans require PCP referral for specialist care.

“Horizon is doing everything we can to make sure our members get the care they need during the COVID-19 pandemic. We take seriously our partnership with New Jersey’s hospitals and are working closely together to make it easier for them to focus all of their resources on delivering critical and life-saving care,” said Allen Karp, Horizon BCBSNJ’s executive vice president for Health Care and Transformation.

“New Jersey’s hospitals are under incredible stress right now. Hospital staff who traditionally handle administrative matters like pre-authorizations are being pulled in to support critical care delivery. Horizon is in regular contact with all of our hospital and health system colleagues and will continue to enable our front-line health care partners as they take care of our members and our communities,” said Karp.

On Saturday, Morristown-based Cigna and Humana, announced that they are waiving all out-of-pocket costs for coronavirus treatments nationwide.