Horizon BCBS Recredentialing Responsibilities

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Compliance with Horizon Blue Cross Blue Shield of New Jersey's recredentialing standards is an ongoing contractual responsibility of all participating physicians and other health care professionals. Participating physicians and other health care professionals are also under a continuing contractual obligation to correct any previously provided credentialing information that is, or becomes, inaccurate.

As required by New Jersey state guidelines and accreditation bodies, all practitioners must be recredentialed every 36 months. Physicians and other health care professionals who fail to update or provide necessary information in a timely manner may have their PPO and/or managed care agreements terminated.

Horizon BCBSNJ works with Medversant®, a leader in technology solutions for the management of health care provider information, to help it carry out its recredentialing process. The following is a high-level overview of our recredentialing process.

  • Nine months prior to your recredentialing due date, Medversant will begin the recredentialing process by searching for current information on the Council for Affordable Quality Healthcare® (CAQH) online Universal Provider Datasource® (UPD). If your information is up-to-date on the UPD, the recredentialing process will continue.
  • If information is either not on the UPD or not current on the UPD, Medversant will contact you to request that updated and/or missing information is made available.
  • If Medversant doesn't receive a response, Horizon BCBSNJ will send you two letters:
    - The initial letter will be mailed 90 days before the recredentialing cycle ends.
    - The final letter will be sent 60 days before the recredentialing cycle ends.
  • If Medversant has not received a response, you will be terminated from Horizon BCBSNJ networks at the end of the month prior to your recredentialing due date.

If you have questions about recredentialing, including questions about your recredentialing status, submission instructions or general process inquiries, please call 1-800-508-5799 and, when prompted, select the option for Questions Regarding Credentialing, and then select the option for Horizon Provider.

Medversant representatives are available Monday through Friday, between 7 a.m. and 10 p.m., Eastern Time.

June 6, 2013 Recredentailing Responsibilities

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