All PlansAdministrativeMedium impact
Helping Members Get Care: In-Home Assessments to Close Care Gaps
Horizon BCBS NJ·Provider News
Effective date
Nov 1, 2023
We identified it
Jun 26, 2026
Summary
Horizon Blue is implementing in-home assessments to close care gaps for members, with multiple concurrent updates including new Provider Portal (Availity Essentials), Provider Services call center hours changes, and policy updates for biosimilars, behavioral health services, and member access initiatives. This is a comprehensive policy update affecting multiple operational and clinical areas.
Action Required
By November 1, 2023: Billing and provider teams must become familiar with new Availity Essentials portal for claims submission and prior authorization processing. Administrative staff should update call center contact procedures for new Provider Services hours. Clinical staff should understand in-home assessment coverage for care gap closure and ensure proper documentation. Pharmacy team should update formulary references for biosimilar Humira coverage under Horizon Pharmacy plans. No immediate claims workflow changes required, but proactive monitoring for specific coverage and coding guidance is recommended.