Horizon eliminates pre-authorization reqs for acute care hospital admissions.

Byline: Anthony Vecchione

Horizon Blue Cross Blue Shield of New Jerseyannounced 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.

[box type="shadow" align="alignright" width="50%" ]

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

[/box]

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...