Administrative policy posted: Network Adequacy of Participating Providers

Horizon BCBSNJ is proud of our extensive network of participating providers throughout our local service area and makes ongoing efforts to help to ensure our enrolled members have in-network access to the medical and surgical specialist care and services they need.

We encourage providers to review our recently posted Network Adequacy of Participating Providers administrative policy which documents the steps we take to help ensure geographical network adequacy for medical and surgical specialists.

In the event that no medical or surgical specialists practice in the members geographic area, as outlined by the New Jersey Department of Banking and Insurance, we will:

• Assist the member in locating the same specialist who is a participating provider with Horizon BCBSNJ who performs the medically necessary services.
• Use the extended network of available participating providers with Horizon BCBSNJ outside of the geographic area.
• Ensure services are provided as close to the member's home as possible when an appropriate participating provider is available.

Please note that our posting of this policy content is merely to document our existing processes and procedures. The intent of this posting is not to announce any changes to current processes and procedures.

If you have questions, please contact your assigned Provider Account Specialist.